|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
IP
|
$2,469.74
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,555.94 |
| Max. Negotiated Rate |
$2,222.77 |
| Rate for Payer: Aetna Commercial |
$2,099.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,605.33
|
| Rate for Payer: Cash Price |
$1,975.79
|
| Rate for Payer: Cofinity Commercial |
$1,728.82
|
| Rate for Payer: Cofinity Commercial |
$2,123.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,728.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,975.79
|
| Rate for Payer: Healthscope Commercial |
$2,222.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,099.28
|
| Rate for Payer: PHP Commercial |
$2,099.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,605.33
|
| Rate for Payer: Priority Health SBD |
$1,555.94
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
OP
|
$2,469.74
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$634.61 |
| Max. Negotiated Rate |
$3,332.79 |
| Rate for Payer: Aetna Commercial |
$2,099.28
|
| Rate for Payer: Aetna Medicare |
$1,231.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,605.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,479.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,479.97
|
| Rate for Payer: BCBS Complete |
$666.34
|
| Rate for Payer: BCBS MAPPO |
$1,183.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,183.98
|
| Rate for Payer: Cash Price |
$1,975.79
|
| Rate for Payer: Cash Price |
$1,975.79
|
| Rate for Payer: Cofinity Commercial |
$2,123.98
|
| Rate for Payer: Cofinity Commercial |
$1,728.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,728.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,975.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,183.98
|
| Rate for Payer: Healthscope Commercial |
$2,222.77
|
| Rate for Payer: Mclaren Medicaid |
$634.61
|
| Rate for Payer: Mclaren Medicare |
$1,183.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,243.18
|
| Rate for Payer: Meridian Medicaid |
$666.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,361.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,099.28
|
| Rate for Payer: PACE Medicare |
$1,124.78
|
| Rate for Payer: PACE SWMI |
$1,183.98
|
| Rate for Payer: PHP Commercial |
$2,099.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,183.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,605.33
|
| Rate for Payer: Priority Health Medicare |
$1,183.98
|
| Rate for Payer: Priority Health SBD |
$1,555.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,183.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,332.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,183.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,183.98
|
| Rate for Payer: UHCCP Medicaid |
$666.58
|
| Rate for Payer: VA VA |
$1,183.98
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$1,132.67
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$713.58 |
| Max. Negotiated Rate |
$1,019.40 |
| Rate for Payer: Aetna Commercial |
$962.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$736.24
|
| Rate for Payer: Cash Price |
$906.14
|
| Rate for Payer: Cofinity Commercial |
$792.87
|
| Rate for Payer: Cofinity Commercial |
$974.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$792.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$906.14
|
| Rate for Payer: Healthscope Commercial |
$1,019.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.77
|
| Rate for Payer: PHP Commercial |
$962.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.24
|
| Rate for Payer: Priority Health SBD |
$713.58
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$1,132.67
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$453.07 |
| Max. Negotiated Rate |
$1,019.40 |
| Rate for Payer: Aetna Commercial |
$962.77
|
| Rate for Payer: Aetna Medicare |
$566.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$736.24
|
| Rate for Payer: BCBS Complete |
$453.07
|
| Rate for Payer: Cash Price |
$906.14
|
| Rate for Payer: Cofinity Commercial |
$792.87
|
| Rate for Payer: Cofinity Commercial |
$974.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$792.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$906.14
|
| Rate for Payer: Healthscope Commercial |
$1,019.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.77
|
| Rate for Payer: PHP Commercial |
$962.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.24
|
| Rate for Payer: Priority Health SBD |
$713.58
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
IP
|
$924.31
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$582.32 |
| Max. Negotiated Rate |
$831.88 |
| Rate for Payer: Aetna Commercial |
$785.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.80
|
| Rate for Payer: Cash Price |
$739.45
|
| Rate for Payer: Cofinity Commercial |
$647.02
|
| Rate for Payer: Cofinity Commercial |
$794.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$647.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.45
|
| Rate for Payer: Healthscope Commercial |
$831.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.66
|
| Rate for Payer: PHP Commercial |
$785.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.80
|
| Rate for Payer: Priority Health SBD |
$582.32
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
OP
|
$924.31
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$369.72 |
| Max. Negotiated Rate |
$831.88 |
| Rate for Payer: Aetna Commercial |
$785.66
|
| Rate for Payer: Aetna Medicare |
$462.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.80
|
| Rate for Payer: BCBS Complete |
$369.72
|
| Rate for Payer: Cash Price |
$739.45
|
| Rate for Payer: Cofinity Commercial |
$647.02
|
| Rate for Payer: Cofinity Commercial |
$794.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$647.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.45
|
| Rate for Payer: Healthscope Commercial |
$831.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.66
|
| Rate for Payer: PHP Commercial |
$785.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.80
|
| Rate for Payer: Priority Health SBD |
$582.32
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
IP
|
$358.94
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.13 |
| Max. Negotiated Rate |
$323.05 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.31
|
| Rate for Payer: Cash Price |
$287.15
|
| Rate for Payer: Cofinity Commercial |
$251.26
|
| Rate for Payer: Cofinity Commercial |
$308.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.15
|
| Rate for Payer: Healthscope Commercial |
$323.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.10
|
| Rate for Payer: PHP Commercial |
$305.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.31
|
| Rate for Payer: Priority Health SBD |
$226.13
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
OP
|
$358.94
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$287.15
|
| Rate for Payer: Cash Price |
$287.15
|
| Rate for Payer: Cofinity Commercial |
$251.26
|
| Rate for Payer: Cofinity Commercial |
$308.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$323.05
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.10
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$305.10
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.31
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$226.13
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
OP
|
$3,955.19
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$3,361.91
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,570.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$3,164.15
|
| Rate for Payer: Cash Price |
$3,164.15
|
| Rate for Payer: Cofinity Commercial |
$3,401.46
|
| Rate for Payer: Cofinity Commercial |
$2,768.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,768.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$3,559.67
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,361.91
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,361.91
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,570.87
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$2,491.77
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
IP
|
$3,955.19
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,491.77 |
| Max. Negotiated Rate |
$3,559.67 |
| Rate for Payer: Aetna Commercial |
$3,361.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,570.87
|
| Rate for Payer: Cash Price |
$3,164.15
|
| Rate for Payer: Cofinity Commercial |
$2,768.63
|
| Rate for Payer: Cofinity Commercial |
$3,401.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,768.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.15
|
| Rate for Payer: Healthscope Commercial |
$3,559.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,361.91
|
| Rate for Payer: PHP Commercial |
$3,361.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,570.87
|
| Rate for Payer: Priority Health SBD |
$2,491.77
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$9,547.08
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,014.66 |
| Max. Negotiated Rate |
$8,592.37 |
| Rate for Payer: Aetna Commercial |
$8,115.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,205.60
|
| Rate for Payer: Cash Price |
$7,637.66
|
| Rate for Payer: Cofinity Commercial |
$6,682.96
|
| Rate for Payer: Cofinity Commercial |
$8,210.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,682.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,637.66
|
| Rate for Payer: Healthscope Commercial |
$8,592.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,115.02
|
| Rate for Payer: PHP Commercial |
$8,115.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,205.60
|
| Rate for Payer: Priority Health SBD |
$6,014.66
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$9,547.08
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$8,115.02
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,205.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$7,637.66
|
| Rate for Payer: Cash Price |
$7,637.66
|
| Rate for Payer: Cofinity Commercial |
$8,210.49
|
| Rate for Payer: Cofinity Commercial |
$6,682.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,682.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,637.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$8,592.37
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,115.02
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$8,115.02
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,205.60
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$6,014.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC NONSTRESS TEST
|
Facility
|
IP
|
$352.44
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$222.04 |
| Max. Negotiated Rate |
$317.20 |
| Rate for Payer: Aetna Commercial |
$299.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.09
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cofinity Commercial |
$246.71
|
| Rate for Payer: Cofinity Commercial |
$303.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.95
|
| Rate for Payer: Healthscope Commercial |
$317.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.57
|
| Rate for Payer: PHP Commercial |
$299.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.09
|
| Rate for Payer: Priority Health SBD |
$222.04
|
|
|
HC NONSTRESS TEST
|
Facility
|
OP
|
$352.44
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$552.28 |
| Rate for Payer: Aetna Commercial |
$299.57
|
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cofinity Commercial |
$303.10
|
| Rate for Payer: Cofinity Commercial |
$246.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$317.20
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.57
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$299.57
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.09
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health SBD |
$222.04
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Core |
$260.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$260.81
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$110.46
|
| Rate for Payer: VA VA |
$196.20
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
OP
|
$3,312.08
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,324.83 |
| Max. Negotiated Rate |
$2,980.87 |
| Rate for Payer: Aetna Commercial |
$2,815.27
|
| Rate for Payer: Aetna Medicare |
$1,656.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,152.85
|
| Rate for Payer: BCBS Complete |
$1,324.83
|
| Rate for Payer: Cash Price |
$2,649.66
|
| Rate for Payer: Cofinity Commercial |
$2,318.46
|
| Rate for Payer: Cofinity Commercial |
$2,848.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,318.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,649.66
|
| Rate for Payer: Healthscope Commercial |
$2,980.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.27
|
| Rate for Payer: PHP Commercial |
$2,815.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,152.85
|
| Rate for Payer: Priority Health SBD |
$2,086.61
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
IP
|
$3,312.08
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,086.61 |
| Max. Negotiated Rate |
$2,980.87 |
| Rate for Payer: Aetna Commercial |
$2,815.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,152.85
|
| Rate for Payer: Cash Price |
$2,649.66
|
| Rate for Payer: Cofinity Commercial |
$2,318.46
|
| Rate for Payer: Cofinity Commercial |
$2,848.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,318.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,649.66
|
| Rate for Payer: Healthscope Commercial |
$2,980.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.27
|
| Rate for Payer: PHP Commercial |
$2,815.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,152.85
|
| Rate for Payer: Priority Health SBD |
$2,086.61
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
OP
|
$4,516.48
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,806.59 |
| Max. Negotiated Rate |
$4,064.83 |
| Rate for Payer: Aetna Commercial |
$3,839.01
|
| Rate for Payer: Aetna Medicare |
$2,258.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,935.71
|
| Rate for Payer: BCBS Complete |
$1,806.59
|
| Rate for Payer: Cash Price |
$3,613.18
|
| Rate for Payer: Cofinity Commercial |
$3,161.54
|
| Rate for Payer: Cofinity Commercial |
$3,884.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,161.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,613.18
|
| Rate for Payer: Healthscope Commercial |
$4,064.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,839.01
|
| Rate for Payer: PHP Commercial |
$3,839.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,935.71
|
| Rate for Payer: Priority Health SBD |
$2,845.38
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
IP
|
$4,516.48
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,845.38 |
| Max. Negotiated Rate |
$4,064.83 |
| Rate for Payer: Aetna Commercial |
$3,839.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,935.71
|
| Rate for Payer: Cash Price |
$3,613.18
|
| Rate for Payer: Cofinity Commercial |
$3,161.54
|
| Rate for Payer: Cofinity Commercial |
$3,884.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,161.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,613.18
|
| Rate for Payer: Healthscope Commercial |
$4,064.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,839.01
|
| Rate for Payer: PHP Commercial |
$3,839.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,935.71
|
| Rate for Payer: Priority Health SBD |
$2,845.38
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health SBD |
$15.73
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$52.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| 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 |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| 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 |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$15.73
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$10.49
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health SBD |
$27.63
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| Rate for Payer: BCBS Complete |
$17.54
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health SBD |
$27.63
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
OP
|
$414.53
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.81 |
| Max. Negotiated Rate |
$373.08 |
| Rate for Payer: Aetna Commercial |
$352.35
|
| Rate for Payer: Aetna Medicare |
$207.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.44
|
| Rate for Payer: BCBS Complete |
$165.81
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$290.17
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$373.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: PHP Commercial |
$352.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health SBD |
$261.15
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
IP
|
$414.53
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$261.15 |
| Max. Negotiated Rate |
$373.08 |
| Rate for Payer: Aetna Commercial |
$352.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.44
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$290.17
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$373.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: PHP Commercial |
$352.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health SBD |
$261.15
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
OP
|
$948.26
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$806.02
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.37
|
| 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 |
$758.61
|
| Rate for Payer: Cash Price |
$758.61
|
| Rate for Payer: Cofinity Commercial |
$815.50
|
| Rate for Payer: Cofinity Commercial |
$663.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$663.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$853.43
|
| 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 |
$806.02
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$806.02
|
| 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 |
$616.37
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$597.40
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$701.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$701.71
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
