|
HC PTCA ADD/BRANCH
|
Facility
|
OP
|
$7,290.61
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,916.24 |
| Max. Negotiated Rate |
$6,561.55 |
| Rate for Payer: Aetna Commercial |
$6,197.02
|
| Rate for Payer: Aetna Medicare |
$3,645.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,738.90
|
| Rate for Payer: BCBS Complete |
$2,916.24
|
| Rate for Payer: Cash Price |
$5,832.49
|
| Rate for Payer: Cofinity Commercial |
$5,103.43
|
| Rate for Payer: Cofinity Commercial |
$6,269.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,103.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,832.49
|
| Rate for Payer: Healthscope Commercial |
$6,561.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,197.02
|
| Rate for Payer: PHP Commercial |
$6,197.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,738.90
|
| Rate for Payer: Priority Health SBD |
$4,593.08
|
|
|
HC PTCA VESSEL/BRANCH
|
Facility
|
OP
|
$11,199.75
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,980.47 |
| Max. Negotiated Rate |
$15,652.48 |
| Rate for Payer: Aetna Commercial |
$9,519.79
|
| Rate for Payer: Aetna Medicare |
$5,783.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,279.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,950.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,950.73
|
| Rate for Payer: BCBS Complete |
$3,129.49
|
| Rate for Payer: BCBS MAPPO |
$5,560.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,560.58
|
| Rate for Payer: Cash Price |
$8,959.80
|
| Rate for Payer: Cash Price |
$8,959.80
|
| Rate for Payer: Cofinity Commercial |
$7,839.82
|
| Rate for Payer: Cofinity Commercial |
$9,631.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,839.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,959.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,560.58
|
| Rate for Payer: Healthscope Commercial |
$10,079.77
|
| Rate for Payer: Mclaren Medicaid |
$2,980.47
|
| Rate for Payer: Mclaren Medicare |
$5,560.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,838.61
|
| Rate for Payer: Meridian Medicaid |
$3,129.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,394.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,519.79
|
| Rate for Payer: PACE Medicare |
$5,282.55
|
| Rate for Payer: PACE SWMI |
$5,560.58
|
| Rate for Payer: PHP Commercial |
$9,519.79
|
| Rate for Payer: PHP Medicare Advantage |
$5,560.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,980.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,279.84
|
| Rate for Payer: Priority Health Medicare |
$5,560.58
|
| Rate for Payer: Priority Health SBD |
$7,055.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5,560.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,652.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,560.58
|
| Rate for Payer: UHC Medicare Advantage |
$5,560.58
|
| Rate for Payer: UHCCP Medicaid |
$3,130.61
|
| Rate for Payer: VA VA |
$5,560.58
|
|
|
HC PTCA VESSEL/BRANCH
|
Facility
|
IP
|
$11,199.75
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,055.84 |
| Max. Negotiated Rate |
$10,079.77 |
| Rate for Payer: Aetna Commercial |
$9,519.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,279.84
|
| Rate for Payer: Cash Price |
$8,959.80
|
| Rate for Payer: Cofinity Commercial |
$7,839.82
|
| Rate for Payer: Cofinity Commercial |
$9,631.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,839.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,959.80
|
| Rate for Payer: Healthscope Commercial |
$10,079.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,519.79
|
| Rate for Payer: PHP Commercial |
$9,519.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,279.84
|
| Rate for Payer: Priority Health SBD |
$7,055.84
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
OP
|
$19,101.90
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,640.76 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna Commercial |
$16,236.61
|
| Rate for Payer: Aetna Medicare |
$9,550.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,416.24
|
| Rate for Payer: BCBS Complete |
$7,640.76
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$13,371.33
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,371.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.61
|
| Rate for Payer: PHP Commercial |
$16,236.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health SBD |
$12,034.20
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
IP
|
$19,101.90
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,034.20 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna Commercial |
$16,236.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,416.24
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$13,371.33
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,371.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.61
|
| Rate for Payer: PHP Commercial |
$16,236.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health SBD |
$12,034.20
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
IP
|
$29,158.60
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,369.92 |
| Max. Negotiated Rate |
$26,242.74 |
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,953.09
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$20,411.02
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,411.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health SBD |
$18,369.92
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
OP
|
$29,158.60
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,953.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$20,411.02
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,411.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health SBD |
$18,369.92
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,296.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,859.72
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
IP
|
$11,940.30
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,522.39 |
| Max. Negotiated Rate |
$10,746.27 |
| Rate for Payer: Aetna Commercial |
$10,149.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,761.19
|
| Rate for Payer: Cash Price |
$9,552.24
|
| Rate for Payer: Cofinity Commercial |
$10,268.66
|
| Rate for Payer: Cofinity Commercial |
$8,358.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,358.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,552.24
|
| Rate for Payer: Healthscope Commercial |
$10,746.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,149.25
|
| Rate for Payer: PHP Commercial |
$10,149.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,761.19
|
| Rate for Payer: Priority Health SBD |
$7,522.39
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
OP
|
$11,940.30
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,776.12 |
| Max. Negotiated Rate |
$10,746.27 |
| Rate for Payer: Aetna Commercial |
$10,149.25
|
| Rate for Payer: Aetna Medicare |
$5,970.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,761.19
|
| Rate for Payer: BCBS Complete |
$4,776.12
|
| Rate for Payer: Cash Price |
$9,552.24
|
| Rate for Payer: Cofinity Commercial |
$10,268.66
|
| Rate for Payer: Cofinity Commercial |
$8,358.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,358.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,552.24
|
| Rate for Payer: Healthscope Commercial |
$10,746.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,149.25
|
| Rate for Payer: PHP Commercial |
$10,149.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,761.19
|
| Rate for Payer: Priority Health SBD |
$7,522.39
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
OP
|
$19,101.90
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,640.76 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna Commercial |
$16,236.61
|
| Rate for Payer: Aetna Medicare |
$9,550.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,416.24
|
| Rate for Payer: BCBS Complete |
$7,640.76
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$13,371.33
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,371.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.61
|
| Rate for Payer: PHP Commercial |
$16,236.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health SBD |
$12,034.20
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
IP
|
$19,101.90
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,034.20 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna Commercial |
$16,236.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,416.24
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$13,371.33
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,371.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.61
|
| Rate for Payer: PHP Commercial |
$16,236.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health SBD |
$12,034.20
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
OP
|
$29,158.60
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,953.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$20,411.02
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,411.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health SBD |
$18,369.92
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,296.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,859.72
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
IP
|
$29,158.60
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,369.92 |
| Max. Negotiated Rate |
$26,242.74 |
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,953.09
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$20,411.02
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,411.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health SBD |
$18,369.92
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$314.72
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$198.27 |
| Max. Negotiated Rate |
$283.25 |
| Rate for Payer: Aetna Commercial |
$267.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.57
|
| Rate for Payer: Cash Price |
$251.78
|
| Rate for Payer: Cofinity Commercial |
$220.30
|
| Rate for Payer: Cofinity Commercial |
$270.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.78
|
| Rate for Payer: Healthscope Commercial |
$283.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.51
|
| Rate for Payer: PHP Commercial |
$267.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.57
|
| Rate for Payer: Priority Health SBD |
$198.27
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$314.72
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$125.89 |
| Max. Negotiated Rate |
$283.25 |
| Rate for Payer: Aetna Commercial |
$267.51
|
| Rate for Payer: Aetna Medicare |
$157.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.57
|
| Rate for Payer: BCBS Complete |
$125.89
|
| Rate for Payer: Cash Price |
$251.78
|
| Rate for Payer: Cash Price |
$251.78
|
| Rate for Payer: Cofinity Commercial |
$270.66
|
| Rate for Payer: Cofinity Commercial |
$220.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.78
|
| Rate for Payer: Healthscope Commercial |
$283.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.51
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$267.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.57
|
| Rate for Payer: Priority Health SBD |
$198.27
|
| Rate for Payer: UHC Core |
$232.89
|
| Rate for Payer: UHC Exchange |
$232.89
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$257.50
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$231.75 |
| Rate for Payer: Aetna Commercial |
$218.88
|
| Rate for Payer: Aetna Medicare |
$128.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.38
|
| Rate for Payer: BCBS Complete |
$103.00
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cofinity Commercial |
$221.45
|
| Rate for Payer: Cofinity Commercial |
$180.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.00
|
| Rate for Payer: Healthscope Commercial |
$231.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.88
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$218.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.38
|
| Rate for Payer: Priority Health SBD |
$162.22
|
| Rate for Payer: UHC Core |
$190.55
|
| Rate for Payer: UHC Exchange |
$190.55
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$257.50
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$162.22 |
| Max. Negotiated Rate |
$231.75 |
| Rate for Payer: Aetna Commercial |
$218.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.38
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cofinity Commercial |
$180.25
|
| Rate for Payer: Cofinity Commercial |
$221.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.00
|
| Rate for Payer: Healthscope Commercial |
$231.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.88
|
| Rate for Payer: PHP Commercial |
$218.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.38
|
| Rate for Payer: Priority Health SBD |
$162.22
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Cofinity Commercial |
$200.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: Priority Health SBD |
$180.25
|
| Rate for Payer: UHC Core |
$211.72
|
| Rate for Payer: UHC Exchange |
$211.72
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: Priority Health SBD |
$180.25
|
|
|
HC PT MIX 1:1
|
Facility
|
IP
|
$70.44
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.38 |
| Max. Negotiated Rate |
$63.40 |
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.79
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$49.31
|
| Rate for Payer: Cofinity Commercial |
$60.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.35
|
| Rate for Payer: Healthscope Commercial |
$63.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.87
|
| Rate for Payer: PHP Commercial |
$59.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.79
|
| Rate for Payer: Priority Health SBD |
$44.38
|
|
|
HC PT MIX 1:1
|
Facility
|
OP
|
$70.44
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$63.40 |
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: Aetna Medicare |
$4.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.92
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$3.94
|
| Rate for Payer: BCN Medicare Advantage |
$3.94
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$60.58
|
| Rate for Payer: Cofinity Commercial |
$49.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$63.40
|
| Rate for Payer: Mclaren Medicaid |
$2.11
|
| Rate for Payer: Mclaren Medicare |
$3.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.14
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.87
|
| Rate for Payer: PACE Medicare |
$3.74
|
| Rate for Payer: PACE SWMI |
$3.94
|
| Rate for Payer: PHP Commercial |
$59.87
|
| Rate for Payer: PHP Medicare Advantage |
$3.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.79
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: Priority Health SBD |
$44.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.94
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| Rate for Payer: UHCCP Medicaid |
$2.22
|
| Rate for Payer: VA VA |
$3.94
|
|
|
HC PT NEUROSTIM
|
Facility
|
IP
|
$97.14
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$87.43 |
| Rate for Payer: Aetna Commercial |
$82.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.14
|
| Rate for Payer: Cash Price |
$77.71
|
| Rate for Payer: Cofinity Commercial |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$83.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.71
|
| Rate for Payer: Healthscope Commercial |
$87.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.57
|
| Rate for Payer: PHP Commercial |
$82.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.14
|
| Rate for Payer: Priority Health SBD |
$61.20
|
|
|
HC PT NEUROSTIM
|
Facility
|
OP
|
$97.14
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.86 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$82.57
|
| Rate for Payer: Aetna Medicare |
$48.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.14
|
| Rate for Payer: BCBS Complete |
$38.86
|
| Rate for Payer: Cash Price |
$77.71
|
| Rate for Payer: Cash Price |
$77.71
|
| Rate for Payer: Cofinity Commercial |
$83.54
|
| Rate for Payer: Cofinity Commercial |
$68.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.71
|
| Rate for Payer: Healthscope Commercial |
$87.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.57
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$82.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.14
|
| Rate for Payer: Priority Health SBD |
$61.20
|
| Rate for Payer: UHC Core |
$71.88
|
| Rate for Payer: UHC Exchange |
$71.88
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$128.16
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$80.74 |
| Max. Negotiated Rate |
$115.34 |
| Rate for Payer: Aetna Commercial |
$108.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.30
|
| Rate for Payer: Cash Price |
$102.53
|
| Rate for Payer: Cofinity Commercial |
$110.22
|
| Rate for Payer: Cofinity Commercial |
$89.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.53
|
| Rate for Payer: Healthscope Commercial |
$115.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.94
|
| Rate for Payer: PHP Commercial |
$108.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health SBD |
$80.74
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$128.16
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$51.26 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$108.94
|
| Rate for Payer: Aetna Medicare |
$64.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.30
|
| Rate for Payer: BCBS Complete |
$51.26
|
| Rate for Payer: Cash Price |
$102.53
|
| Rate for Payer: Cash Price |
$102.53
|
| Rate for Payer: Cofinity Commercial |
$89.71
|
| Rate for Payer: Cofinity Commercial |
$110.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.53
|
| Rate for Payer: Healthscope Commercial |
$115.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.94
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$108.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health SBD |
$80.74
|
| Rate for Payer: UHC Core |
$94.84
|
| Rate for Payer: UHC Exchange |
$94.84
|
|
