|
HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS
|
Facility
|
OP
|
$1,363.87
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
36100503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna Commercial |
$1,159.29
|
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$886.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$1,091.10
|
| Rate for Payer: Cash Price |
$1,091.10
|
| Rate for Payer: Cofinity Commercial |
$954.71
|
| Rate for Payer: Cofinity Commercial |
$1,172.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$954.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,091.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$1,227.48
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,159.29
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$1,159.29
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$886.52
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health SBD |
$859.24
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$366.50
|
| Rate for Payer: VA VA |
$650.97
|
|
|
HC NEPHROSTOGRAM URETEROGRAM NEW ACCESS
|
Facility
|
OP
|
$1,204.40
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
36100502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna Commercial |
$1,023.74
|
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$782.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cofinity Commercial |
$843.08
|
| Rate for Payer: Cofinity Commercial |
$1,035.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$843.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$1,083.96
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.74
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$1,023.74
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.86
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health SBD |
$758.77
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$366.50
|
| Rate for Payer: VA VA |
$650.97
|
|
|
HC NEPHROSTOGRAM URETEROGRAM NEW ACCESS
|
Facility
|
IP
|
$1,204.40
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
36100502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.77 |
| Max. Negotiated Rate |
$1,083.96 |
| Rate for Payer: Aetna Commercial |
$1,023.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$782.86
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cofinity Commercial |
$1,035.78
|
| Rate for Payer: Cofinity Commercial |
$843.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$843.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.52
|
| Rate for Payer: Healthscope Commercial |
$1,083.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.74
|
| Rate for Payer: PHP Commercial |
$1,023.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.86
|
| Rate for Payer: Priority Health SBD |
$758.77
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL EA ADDL LEVEL
|
Facility
|
IP
|
$1,491.41
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
36100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$939.59 |
| Max. Negotiated Rate |
$1,342.27 |
| Rate for Payer: Aetna Commercial |
$1,267.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.42
|
| Rate for Payer: Cash Price |
$1,193.13
|
| Rate for Payer: Cofinity Commercial |
$1,043.99
|
| Rate for Payer: Cofinity Commercial |
$1,282.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,043.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.13
|
| Rate for Payer: Healthscope Commercial |
$1,342.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,267.70
|
| Rate for Payer: PHP Commercial |
$1,267.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.42
|
| Rate for Payer: Priority Health SBD |
$939.59
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL EA ADDL LEVEL
|
Facility
|
OP
|
$1,491.41
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
36100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna Commercial |
$1,267.70
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,193.13
|
| Rate for Payer: Cash Price |
$1,193.13
|
| Rate for Payer: Cofinity Commercial |
$1,282.61
|
| Rate for Payer: Cofinity Commercial |
$1,043.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,043.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,342.27
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,267.70
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$1,267.70
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.42
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$939.59
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$488.84
|
| Rate for Payer: VA VA |
$868.28
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL SINGLE
|
Facility
|
OP
|
$758.70
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
36100403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.01 |
| Max. Negotiated Rate |
$1,901.18 |
| Rate for Payer: Aetna Commercial |
$644.89
|
| Rate for Payer: Aetna Medicare |
$702.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$606.96
|
| Rate for Payer: Cash Price |
$606.96
|
| Rate for Payer: Cofinity Commercial |
$652.48
|
| Rate for Payer: Cofinity Commercial |
$531.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$682.83
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.89
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$644.89
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.15
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health SBD |
$477.98
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$380.25
|
| Rate for Payer: VA VA |
$675.40
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL SINGLE
|
Facility
|
IP
|
$758.70
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
36100403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$477.98 |
| Max. Negotiated Rate |
$682.83 |
| Rate for Payer: Aetna Commercial |
$644.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.15
|
| Rate for Payer: Cash Price |
$606.96
|
| Rate for Payer: Cofinity Commercial |
$531.09
|
| Rate for Payer: Cofinity Commercial |
$652.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.96
|
| Rate for Payer: Healthscope Commercial |
$682.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.89
|
| Rate for Payer: PHP Commercial |
$644.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.15
|
| Rate for Payer: Priority Health SBD |
$477.98
|
|
|
HC NETTLE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200049
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC NETTLE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200049
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM EA ADDL HR
|
Facility
|
OP
|
$135.25
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
91800006
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$121.72 |
| Rate for Payer: Aetna Commercial |
$114.96
|
| Rate for Payer: Aetna Medicare |
$67.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.91
|
| Rate for Payer: BCBS Complete |
$54.10
|
| Rate for Payer: Cash Price |
$108.20
|
| Rate for Payer: Cofinity Commercial |
$116.31
|
| Rate for Payer: Cofinity Commercial |
$94.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.20
|
| Rate for Payer: Healthscope Commercial |
$121.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.96
|
| Rate for Payer: PHP Commercial |
$114.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.91
|
| Rate for Payer: Priority Health SBD |
$85.21
|
| Rate for Payer: UHC Core |
$100.08
|
| Rate for Payer: UHC Exchange |
$100.08
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM EA ADDL HR
|
Facility
|
IP
|
$135.25
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
91800006
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$121.72 |
| Rate for Payer: Aetna Commercial |
$114.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.91
|
| Rate for Payer: Cash Price |
$108.20
|
| Rate for Payer: Cofinity Commercial |
$116.31
|
| Rate for Payer: Cofinity Commercial |
$94.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.20
|
| Rate for Payer: Healthscope Commercial |
$121.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.96
|
| Rate for Payer: PHP Commercial |
$114.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.91
|
| Rate for Payer: Priority Health SBD |
$85.21
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM FIRST HOUR
|
Facility
|
IP
|
$275.10
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
91800001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$173.31 |
| Max. Negotiated Rate |
$247.59 |
| Rate for Payer: Aetna Commercial |
$233.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.81
|
| Rate for Payer: Cash Price |
$220.08
|
| Rate for Payer: Cofinity Commercial |
$192.57
|
| Rate for Payer: Cofinity Commercial |
$236.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.08
|
| Rate for Payer: Healthscope Commercial |
$247.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.84
|
| Rate for Payer: PHP Commercial |
$233.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.81
|
| Rate for Payer: Priority Health SBD |
$173.31
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM FIRST HOUR
|
Facility
|
OP
|
$275.10
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
91800001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$233.84
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$220.08
|
| Rate for Payer: Cash Price |
$220.08
|
| Rate for Payer: Cofinity Commercial |
$192.57
|
| Rate for Payer: Cofinity Commercial |
$236.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$247.59
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.84
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$233.84
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.81
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$173.31
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$203.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$203.57
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC NEUROFORM ATLAS STENT
|
Facility
|
OP
|
$11,880.07
|
|
| Hospital Charge Code |
27800118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,752.03 |
| Max. Negotiated Rate |
$10,692.06 |
| Rate for Payer: Aetna Commercial |
$10,098.06
|
| Rate for Payer: Aetna Medicare |
$5,940.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,722.05
|
| Rate for Payer: BCBS Complete |
$4,752.03
|
| Rate for Payer: Cash Price |
$9,504.06
|
| Rate for Payer: Cofinity Commercial |
$10,216.86
|
| Rate for Payer: Cofinity Commercial |
$8,316.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,316.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,504.06
|
| Rate for Payer: Healthscope Commercial |
$10,692.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,098.06
|
| Rate for Payer: PHP Commercial |
$10,098.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,722.05
|
| Rate for Payer: Priority Health SBD |
$7,484.44
|
|
|
HC NEUROFORM ATLAS STENT
|
Facility
|
IP
|
$11,880.07
|
|
| Hospital Charge Code |
27800118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,484.44 |
| Max. Negotiated Rate |
$10,692.06 |
| Rate for Payer: Aetna Commercial |
$10,098.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,722.05
|
| Rate for Payer: Cash Price |
$9,504.06
|
| Rate for Payer: Cofinity Commercial |
$10,216.86
|
| Rate for Payer: Cofinity Commercial |
$8,316.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,316.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,504.06
|
| Rate for Payer: Healthscope Commercial |
$10,692.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,098.06
|
| Rate for Payer: PHP Commercial |
$10,098.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,722.05
|
| Rate for Payer: Priority Health SBD |
$7,484.44
|
|
|
HC NEUROLYSIS CELIAC PLEXUS
|
Facility
|
OP
|
$1,929.94
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
36100479
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna Commercial |
$1,640.45
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,254.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,543.95
|
| Rate for Payer: Cash Price |
$1,543.95
|
| Rate for Payer: Cofinity Commercial |
$1,659.75
|
| Rate for Payer: Cofinity Commercial |
$1,350.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,350.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,543.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,736.95
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,640.45
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$1,640.45
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,254.46
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$1,215.86
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$488.84
|
| Rate for Payer: VA VA |
$868.28
|
|
|
HC NEUROLYSIS CELIAC PLEXUS
|
Facility
|
IP
|
$1,929.94
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
36100479
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,215.86 |
| Max. Negotiated Rate |
$1,736.95 |
| Rate for Payer: Aetna Commercial |
$1,640.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,254.46
|
| Rate for Payer: Cash Price |
$1,543.95
|
| Rate for Payer: Cofinity Commercial |
$1,350.96
|
| Rate for Payer: Cofinity Commercial |
$1,659.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,350.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,543.95
|
| Rate for Payer: Healthscope Commercial |
$1,736.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,640.45
|
| Rate for Payer: PHP Commercial |
$1,640.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,254.46
|
| Rate for Payer: Priority Health SBD |
$1,215.86
|
|
|
HC NEURONAL (V-G)K+ CHANNEL AB
|
Facility
|
OP
|
$68.67
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$61.80 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.64
|
| 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 |
$10.36
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$59.06
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$61.80
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| 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 |
$10.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$58.37
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$43.26
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Medicare Advantage |
$18.40
|
| Rate for Payer: UHCCP Medicaid |
$10.36
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC NEURONAL (V-G)K+ CHANNEL AB
|
Facility
|
IP
|
$68.67
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$61.80 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.64
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$59.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Healthscope Commercial |
$61.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: PHP Commercial |
$58.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health SBD |
$43.26
|
|
|
HC NEURON SPECIFIC ENOLASE
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC NEURON SPECIFIC ENOLASE
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health SBD |
$44.57
|
|
|
HC NEUROPSYCH TEST EVAL BY PHYS FIRST HR
|
Facility
|
IP
|
$69.71
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
91800007
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.31
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.31
|
| Rate for Payer: Priority Health SBD |
$43.92
|
|
|
HC NEUROPSYCH TEST EVAL BY PHYS FIRST HR
|
Facility
|
OP
|
$69.71
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
91800007
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$43.92
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Core |
$51.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$51.59
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC NEUROPSYCH TEST EVAL EA ADDL HR
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
91800008
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
|
|
HC NEUROPSYCH TEST EVAL EA ADDL HR
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
91800008
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: UHC Core |
$26.94
|
| Rate for Payer: UHC Exchange |
$26.94
|
|
