|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$9,738.02
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,620.74 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$8,277.32
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,329.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.74
|
| Rate for Payer: BCN Commercial |
$1,620.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Advantage |
$6,816.61
|
| Rate for Payer: Cofinity Commercial |
$8,374.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$8,764.22
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$8,277.32
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$6,134.95
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$9,738.02
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,134.95 |
| Max. Negotiated Rate |
$8,764.22 |
| Rate for Payer: Aetna Commercial |
$8,277.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,329.71
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Advantage |
$6,816.61
|
| Rate for Payer: Cofinity Commercial |
$8,374.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Healthscope Commercial |
$8,764.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: PHP Commercial |
$8,277.32
|
| Rate for Payer: Priority Health SBD |
$6,134.95
|
|
|
HC NONSTRESS TEST
|
Facility
|
OP
|
$359.49
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$651.46 |
| Rate for Payer: Aetna Commercial |
$305.57
|
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$146.87
|
| Rate for Payer: BCN Commercial |
$146.87
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cofinity Advantage |
$251.64
|
| Rate for Payer: Cofinity Commercial |
$309.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$323.54
|
| Rate for Payer: Mclaren Medicaid |
$105.35
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.57
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.62
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$305.57
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health SBD |
$226.48
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.67
|
| Rate for Payer: UHC Core |
$187.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$141.28
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
HC NONSTRESS TEST
|
Facility
|
IP
|
$359.49
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$226.48 |
| Max. Negotiated Rate |
$323.54 |
| Rate for Payer: Aetna Commercial |
$305.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.67
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cofinity Advantage |
$251.64
|
| Rate for Payer: Cofinity Commercial |
$309.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.59
|
| Rate for Payer: Healthscope Commercial |
$323.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.62
|
| Rate for Payer: PHP Commercial |
$305.57
|
| Rate for Payer: Priority Health SBD |
$226.48
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
OP
|
$3,378.32
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$614.85 |
| Max. Negotiated Rate |
$3,040.49 |
| Rate for Payer: Aetna Commercial |
$2,871.57
|
| Rate for Payer: Aetna Medicare |
$1,689.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,195.91
|
| Rate for Payer: BCBS Complete |
$1,351.33
|
| Rate for Payer: BCBS Trust/PPO |
$614.85
|
| Rate for Payer: BCN Commercial |
$614.85
|
| Rate for Payer: Cash Price |
$2,702.66
|
| Rate for Payer: Cash Price |
$2,702.66
|
| Rate for Payer: Cofinity Advantage |
$2,364.82
|
| Rate for Payer: Cofinity Commercial |
$2,905.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,702.66
|
| Rate for Payer: Healthscope Commercial |
$3,040.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,702.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,871.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,533.74
|
| Rate for Payer: PHP Commercial |
$2,871.57
|
| Rate for Payer: Priority Health SBD |
$2,128.34
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
IP
|
$3,378.32
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,128.34 |
| Max. Negotiated Rate |
$3,040.49 |
| Rate for Payer: Aetna Commercial |
$2,871.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,195.91
|
| Rate for Payer: Cash Price |
$2,702.66
|
| Rate for Payer: Cofinity Advantage |
$2,364.82
|
| Rate for Payer: Cofinity Commercial |
$2,905.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,702.66
|
| Rate for Payer: Healthscope Commercial |
$3,040.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,871.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,533.74
|
| Rate for Payer: PHP Commercial |
$2,871.57
|
| Rate for Payer: Priority Health SBD |
$2,128.34
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
IP
|
$4,606.81
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,902.29 |
| Max. Negotiated Rate |
$4,146.13 |
| Rate for Payer: Aetna Commercial |
$3,915.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,994.43
|
| Rate for Payer: Cash Price |
$3,685.45
|
| Rate for Payer: Cofinity Advantage |
$3,224.77
|
| Rate for Payer: Cofinity Commercial |
$3,961.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,685.45
|
| Rate for Payer: Healthscope Commercial |
$4,146.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,915.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,455.11
|
| Rate for Payer: PHP Commercial |
$3,915.79
|
| Rate for Payer: Priority Health SBD |
$2,902.29
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
OP
|
$4,606.81
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,446.13 |
| Max. Negotiated Rate |
$4,146.13 |
| Rate for Payer: Aetna Commercial |
$3,915.79
|
| Rate for Payer: Aetna Medicare |
$2,303.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,994.43
|
| Rate for Payer: BCBS Complete |
$1,842.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,446.13
|
| Rate for Payer: BCN Commercial |
$1,446.13
|
| Rate for Payer: Cash Price |
$3,685.45
|
| Rate for Payer: Cash Price |
$3,685.45
|
| Rate for Payer: Cofinity Advantage |
$3,224.77
|
| Rate for Payer: Cofinity Commercial |
$3,961.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,685.45
|
| Rate for Payer: Healthscope Commercial |
$4,146.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,685.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,915.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,455.11
|
| Rate for Payer: PHP Commercial |
$3,915.79
|
| Rate for Payer: Priority Health SBD |
$2,902.29
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$25.47
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Advantage |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: Priority Health SBD |
$16.05
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$25.47
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Advantage |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Mclaren Medicaid |
$9.75
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$16.05
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Advantage |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health SBD |
$28.19
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$22.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: BCBS Complete |
$17.90
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Advantage |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health SBD |
$28.19
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
IP
|
$422.82
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.38 |
| Max. Negotiated Rate |
$380.54 |
| Rate for Payer: Aetna Commercial |
$359.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.83
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Advantage |
$295.97
|
| Rate for Payer: Cofinity Commercial |
$363.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$380.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: PHP Commercial |
$359.40
|
| Rate for Payer: Priority Health SBD |
$266.38
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
OP
|
$422.82
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$380.54 |
| Rate for Payer: Aetna Commercial |
$359.40
|
| Rate for Payer: Aetna Medicare |
$211.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.83
|
| Rate for Payer: BCBS Complete |
$169.13
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Advantage |
$295.97
|
| Rate for Payer: Cofinity Commercial |
$363.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$380.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: PHP Commercial |
$359.40
|
| Rate for Payer: Priority Health SBD |
$266.38
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
OP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$870.51 |
| Rate for Payer: Aetna Commercial |
$822.15
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.70
|
| 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: BCBS Trust/PPO |
$167.28
|
| Rate for Payer: BCN Commercial |
$167.28
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Advantage |
$677.06
|
| Rate for Payer: Cofinity Commercial |
$831.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$870.51
|
| 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 |
$822.15
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$822.15
|
| 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 |
$609.35
|
| 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) |
$628.70
|
| Rate for Payer: UHC Core |
$503.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$380.12
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
IP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$609.35 |
| Max. Negotiated Rate |
$870.51 |
| Rate for Payer: Aetna Commercial |
$822.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.70
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Advantage |
$677.06
|
| Rate for Payer: Cofinity Commercial |
$831.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Healthscope Commercial |
$870.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: PHP Commercial |
$822.15
|
| Rate for Payer: Priority Health SBD |
$609.35
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
OP
|
$220.29
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.57 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$187.25
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$111.78
|
| Rate for Payer: BCN Commercial |
$111.78
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cofinity Advantage |
$154.20
|
| Rate for Payer: Cofinity Commercial |
$189.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$198.26
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.25
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.22
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$187.25
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$138.78
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.19
|
| Rate for Payer: UHC Core |
$114.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$86.57
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
IP
|
$220.29
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$198.26 |
| Rate for Payer: Aetna Commercial |
$187.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.19
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cofinity Advantage |
$154.20
|
| Rate for Payer: Cofinity Commercial |
$189.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.23
|
| Rate for Payer: Healthscope Commercial |
$198.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.22
|
| Rate for Payer: PHP Commercial |
$187.25
|
| Rate for Payer: Priority Health SBD |
$138.78
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$628.77
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$565.89 |
| Rate for Payer: Aetna Commercial |
$534.45
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$503.02
|
| Rate for Payer: Cash Price |
$503.02
|
| Rate for Payer: Cofinity Advantage |
$440.14
|
| Rate for Payer: Cofinity Commercial |
$540.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$503.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$565.89
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.45
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.58
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$534.45
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$396.13
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$628.77
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$396.13 |
| Max. Negotiated Rate |
$565.89 |
| Rate for Payer: Aetna Commercial |
$534.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.70
|
| Rate for Payer: Cash Price |
$503.02
|
| Rate for Payer: Cofinity Advantage |
$440.14
|
| Rate for Payer: Cofinity Commercial |
$540.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$503.02
|
| Rate for Payer: Healthscope Commercial |
$565.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.58
|
| Rate for Payer: PHP Commercial |
$534.45
|
| Rate for Payer: Priority Health SBD |
$396.13
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
OP
|
$335.55
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$285.22
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: Cofinity Advantage |
$234.88
|
| Rate for Payer: Cofinity Commercial |
$288.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.22
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.66
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$285.22
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$211.40
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
IP
|
$335.55
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna Commercial |
$285.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.11
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: Cofinity Advantage |
$234.88
|
| Rate for Payer: Cofinity Commercial |
$288.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.44
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.66
|
| Rate for Payer: PHP Commercial |
$285.22
|
| Rate for Payer: Priority Health SBD |
$211.40
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
IP
|
$315.06
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.49 |
| Max. Negotiated Rate |
$283.55 |
| Rate for Payer: Aetna Commercial |
$267.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.79
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Advantage |
$220.54
|
| Rate for Payer: Cofinity Commercial |
$270.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Healthscope Commercial |
$283.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.29
|
| Rate for Payer: PHP Commercial |
$267.80
|
| Rate for Payer: Priority Health SBD |
$198.49
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
OP
|
$315.06
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$267.80
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Advantage |
$220.54
|
| Rate for Payer: Cofinity Commercial |
$270.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$283.55
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.29
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$267.80
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$198.49
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
IP
|
$303.99
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$191.51 |
| Max. Negotiated Rate |
$273.59 |
| Rate for Payer: Aetna Commercial |
$258.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.59
|
| Rate for Payer: Cash Price |
$243.19
|
| Rate for Payer: Cofinity Advantage |
$212.79
|
| Rate for Payer: Cofinity Commercial |
$261.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.19
|
| Rate for Payer: Healthscope Commercial |
$273.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.99
|
| Rate for Payer: PHP Commercial |
$258.39
|
| Rate for Payer: Priority Health SBD |
$191.51
|
|
