|
HC CARDIOLITE/MIRALUMA STUDY
|
Facility
|
OP
|
$515.54
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$206.22 |
| Max. Negotiated Rate |
$515.54 |
| Rate for Payer: Aetna Commercial |
$463.99
|
| Rate for Payer: Aetna Medicare |
$257.77
|
| Rate for Payer: ASR ASR |
$500.07
|
| Rate for Payer: ASR Commercial |
$500.07
|
| Rate for Payer: BCBS Complete |
$206.22
|
| Rate for Payer: BCBS Trust/PPO |
$422.18
|
| Rate for Payer: BCN Commercial |
$399.70
|
| Rate for Payer: Cash Price |
$412.43
|
| Rate for Payer: Cofinity Commercial |
$484.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.43
|
| Rate for Payer: Healthscope Commercial |
$515.54
|
| Rate for Payer: Healthscope Whirlpool |
$500.07
|
| Rate for Payer: Mclaren Commercial |
$463.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.21
|
| Rate for Payer: Nomi Health Commercial |
$422.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$451.72
|
| Rate for Payer: Priority Health Narrow Network |
$361.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$453.68
|
|
|
HC CARDIOLITE/MIRALUMA STUDY
|
Facility
|
IP
|
$515.54
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$335.10 |
| Max. Negotiated Rate |
$515.54 |
| Rate for Payer: Aetna Commercial |
$463.99
|
| Rate for Payer: ASR ASR |
$500.07
|
| Rate for Payer: ASR Commercial |
$500.07
|
| Rate for Payer: BCBS Trust/PPO |
$420.11
|
| Rate for Payer: BCN Commercial |
$399.70
|
| Rate for Payer: Cash Price |
$412.43
|
| Rate for Payer: Cofinity Commercial |
$484.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.43
|
| Rate for Payer: Healthscope Commercial |
$515.54
|
| Rate for Payer: Healthscope Whirlpool |
$500.07
|
| Rate for Payer: Mclaren Commercial |
$463.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.21
|
| Rate for Payer: Nomi Health Commercial |
$422.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$453.68
|
|
|
HC CARDIOPULMONARY EX TEST
|
Facility
|
IP
|
$1,122.69
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$729.75 |
| Max. Negotiated Rate |
$1,122.69 |
| Rate for Payer: Aetna Commercial |
$1,010.42
|
| Rate for Payer: ASR ASR |
$1,089.01
|
| Rate for Payer: ASR Commercial |
$1,089.01
|
| Rate for Payer: BCBS Trust/PPO |
$914.88
|
| Rate for Payer: BCN Commercial |
$870.42
|
| Rate for Payer: Cash Price |
$898.15
|
| Rate for Payer: Cofinity Commercial |
$1,055.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.15
|
| Rate for Payer: Healthscope Commercial |
$1,122.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.01
|
| Rate for Payer: Mclaren Commercial |
$1,010.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.29
|
| Rate for Payer: Nomi Health Commercial |
$920.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$987.97
|
|
|
HC CARDIOPULMONARY EX TEST
|
Facility
|
OP
|
$1,122.69
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$1,122.69 |
| Rate for Payer: Aetna Commercial |
$1,010.42
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$1,089.01
|
| Rate for Payer: ASR Commercial |
$1,089.01
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$919.37
|
| Rate for Payer: BCN Commercial |
$870.42
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$898.15
|
| Rate for Payer: Cash Price |
$898.15
|
| Rate for Payer: Cofinity Commercial |
$1,055.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,122.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$1,010.42
|
| 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 |
$954.29
|
| Rate for Payer: Nomi Health Commercial |
$920.61
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| 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 |
$729.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$983.70
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$787.01
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$987.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC CARDIOVERSION
|
Facility
|
OP
|
$1,197.85
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
48000002
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$342.08 |
| Max. Negotiated Rate |
$1,197.85 |
| Rate for Payer: Aetna Commercial |
$1,078.07
|
| Rate for Payer: Aetna Medicare |
$638.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.75
|
| Rate for Payer: ASR ASR |
$1,161.91
|
| Rate for Payer: ASR Commercial |
$1,161.91
|
| Rate for Payer: BCBS Complete |
$359.18
|
| Rate for Payer: BCBS MAPPO |
$638.20
|
| Rate for Payer: BCBS Trust/PPO |
$980.92
|
| Rate for Payer: BCN Commercial |
$928.69
|
| Rate for Payer: BCN Medicare Advantage |
$638.20
|
| Rate for Payer: Cash Price |
$958.28
|
| Rate for Payer: Cash Price |
$958.28
|
| Rate for Payer: Cofinity Commercial |
$1,125.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$958.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$638.20
|
| Rate for Payer: Healthscope Commercial |
$1,197.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,161.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$638.20
|
| Rate for Payer: Mclaren Commercial |
$1,078.07
|
| Rate for Payer: Mclaren Medicaid |
$342.08
|
| Rate for Payer: Mclaren Medicare |
$638.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$670.11
|
| Rate for Payer: Meridian Medicaid |
$359.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,018.17
|
| Rate for Payer: Nomi Health Commercial |
$982.24
|
| Rate for Payer: PACE Medicare |
$606.29
|
| Rate for Payer: PACE SWMI |
$638.20
|
| Rate for Payer: PHP Commercial |
$702.02
|
| Rate for Payer: PHP Medicaid |
$342.08
|
| Rate for Payer: PHP Medicare Advantage |
$638.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,049.56
|
| Rate for Payer: Priority Health Medicare |
$638.20
|
| Rate for Payer: Priority Health Narrow Network |
$839.69
|
| Rate for Payer: Railroad Medicare Medicare |
$638.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,054.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$638.20
|
| Rate for Payer: UHC Exchange |
$989.21
|
| Rate for Payer: UHC Medicare Advantage |
$638.20
|
| Rate for Payer: UHCCP DNSP |
$638.20
|
| Rate for Payer: UHCCP Medicaid |
$342.08
|
| Rate for Payer: VA VA |
$638.20
|
|
|
HC CARDIOVERSION
|
Facility
|
IP
|
$1,197.85
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
48000002
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$778.60 |
| Max. Negotiated Rate |
$1,197.85 |
| Rate for Payer: Aetna Commercial |
$1,078.07
|
| Rate for Payer: ASR ASR |
$1,161.91
|
| Rate for Payer: ASR Commercial |
$1,161.91
|
| Rate for Payer: BCBS Trust/PPO |
$976.13
|
| Rate for Payer: BCN Commercial |
$928.69
|
| Rate for Payer: Cash Price |
$958.28
|
| Rate for Payer: Cofinity Commercial |
$1,125.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$958.28
|
| Rate for Payer: Healthscope Commercial |
$1,197.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,161.91
|
| Rate for Payer: Mclaren Commercial |
$1,078.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,018.17
|
| Rate for Payer: Nomi Health Commercial |
$982.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,054.11
|
|
|
HC CARDIOVERSION EXT
|
Facility
|
OP
|
$998.20
|
|
| Hospital Charge Code |
45000034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.28 |
| Max. Negotiated Rate |
$998.20 |
| Rate for Payer: Aetna Commercial |
$898.38
|
| Rate for Payer: Aetna Medicare |
$499.10
|
| Rate for Payer: ASR ASR |
$968.25
|
| Rate for Payer: ASR Commercial |
$968.25
|
| Rate for Payer: BCBS Complete |
$399.28
|
| Rate for Payer: BCBS Trust/PPO |
$817.43
|
| Rate for Payer: BCN Commercial |
$773.90
|
| Rate for Payer: Cash Price |
$798.56
|
| Rate for Payer: Cofinity Commercial |
$938.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.56
|
| Rate for Payer: Healthscope Commercial |
$998.20
|
| Rate for Payer: Healthscope Whirlpool |
$968.25
|
| Rate for Payer: Mclaren Commercial |
$898.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.47
|
| Rate for Payer: Nomi Health Commercial |
$818.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$874.62
|
| Rate for Payer: Priority Health Narrow Network |
$699.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$878.42
|
|
|
HC CARDIOVERSION EXT
|
Facility
|
IP
|
$998.20
|
|
| Hospital Charge Code |
45000034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$648.83 |
| Max. Negotiated Rate |
$998.20 |
| Rate for Payer: Aetna Commercial |
$898.38
|
| Rate for Payer: ASR ASR |
$968.25
|
| Rate for Payer: ASR Commercial |
$968.25
|
| Rate for Payer: BCBS Trust/PPO |
$813.43
|
| Rate for Payer: BCN Commercial |
$773.90
|
| Rate for Payer: Cash Price |
$798.56
|
| Rate for Payer: Cofinity Commercial |
$938.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$798.56
|
| Rate for Payer: Healthscope Commercial |
$998.20
|
| Rate for Payer: Healthscope Whirlpool |
$968.25
|
| Rate for Payer: Mclaren Commercial |
$898.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.47
|
| Rate for Payer: Nomi Health Commercial |
$818.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$878.42
|
|
|
HC CAREGIVER HEALTH RISK ASSMT
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 96161
|
| Hospital Charge Code |
51000095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.49 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: ASR Commercial |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.24
|
| Rate for Payer: BCN Commercial |
$41.14
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$53.06
|
| Rate for Payer: Healthscope Whirlpool |
$51.47
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC CAREGIVER HEALTH RISK ASSMT
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 96161
|
| Hospital Charge Code |
51000095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$29.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.31
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: ASR Commercial |
$51.47
|
| Rate for Payer: BCBS Complete |
$16.35
|
| Rate for Payer: BCBS MAPPO |
$29.05
|
| Rate for Payer: BCBS Trust/PPO |
$43.45
|
| Rate for Payer: BCN Commercial |
$41.14
|
| Rate for Payer: BCN Medicare Advantage |
$29.05
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.05
|
| Rate for Payer: Healthscope Commercial |
$53.06
|
| Rate for Payer: Healthscope Whirlpool |
$51.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.05
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$15.57
|
| Rate for Payer: Mclaren Medicare |
$29.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.50
|
| Rate for Payer: Meridian Medicaid |
$16.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: PACE Medicare |
$27.60
|
| Rate for Payer: PACE SWMI |
$29.05
|
| Rate for Payer: PHP Commercial |
$31.95
|
| Rate for Payer: PHP Medicaid |
$15.57
|
| Rate for Payer: PHP Medicare Advantage |
$29.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.49
|
| Rate for Payer: Priority Health Medicare |
$29.05
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$29.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.05
|
| Rate for Payer: UHC Exchange |
$45.03
|
| Rate for Payer: UHC Medicare Advantage |
$29.05
|
| Rate for Payer: UHCCP DNSP |
$29.05
|
| Rate for Payer: UHCCP Medicaid |
$15.57
|
| Rate for Payer: VA VA |
$29.05
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN
|
Facility
|
OP
|
$129.54
|
|
|
Service Code
|
CPT 97550
|
| Hospital Charge Code |
42000065
|
| Min. Negotiated Rate |
$51.82 |
| Max. Negotiated Rate |
$129.54 |
| Rate for Payer: Aetna Commercial |
$116.59
|
| Rate for Payer: Aetna Medicare |
$64.77
|
| Rate for Payer: ASR ASR |
$125.65
|
| Rate for Payer: ASR Commercial |
$125.65
|
| Rate for Payer: BCBS Complete |
$51.82
|
| Rate for Payer: BCBS Trust/PPO |
$106.08
|
| Rate for Payer: BCN Commercial |
$100.43
|
| Rate for Payer: Cash Price |
$103.63
|
| Rate for Payer: Cofinity Commercial |
$121.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.63
|
| Rate for Payer: Healthscope Commercial |
$129.54
|
| Rate for Payer: Healthscope Whirlpool |
$125.65
|
| Rate for Payer: Mclaren Commercial |
$116.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.11
|
| Rate for Payer: Nomi Health Commercial |
$106.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.50
|
| Rate for Payer: Priority Health Narrow Network |
$90.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.00
|
|
|
HC CAREGIVER TRAINING 1ST 30 MIN
|
Facility
|
IP
|
$129.54
|
|
|
Service Code
|
CPT 97550
|
| Hospital Charge Code |
42000065
|
| Min. Negotiated Rate |
$84.20 |
| Max. Negotiated Rate |
$129.54 |
| Rate for Payer: Aetna Commercial |
$116.59
|
| Rate for Payer: ASR ASR |
$125.65
|
| Rate for Payer: ASR Commercial |
$125.65
|
| Rate for Payer: BCBS Trust/PPO |
$105.56
|
| Rate for Payer: BCN Commercial |
$100.43
|
| Rate for Payer: Cash Price |
$103.63
|
| Rate for Payer: Cofinity Commercial |
$121.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.63
|
| Rate for Payer: Healthscope Commercial |
$129.54
|
| Rate for Payer: Healthscope Whirlpool |
$125.65
|
| Rate for Payer: Mclaren Commercial |
$116.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.11
|
| Rate for Payer: Nomi Health Commercial |
$106.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.00
|
|
|
HC CAREGIVER TRAINING EA ADDL 15 MIN
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 97551
|
| Hospital Charge Code |
42000066
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$49.87
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC CAREGIVER TRAINING EA ADDL 15 MIN
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 97551
|
| Hospital Charge Code |
42000066
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$50.12
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.62
|
| Rate for Payer: Priority Health Narrow Network |
$42.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Facility
|
OP
|
$82.19
|
|
|
Service Code
|
CPT 99484
|
| Hospital Charge Code |
51000107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$82.19 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| Rate for Payer: Aetna Medicare |
$29.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.31
|
| Rate for Payer: ASR ASR |
$79.72
|
| Rate for Payer: ASR Commercial |
$79.72
|
| Rate for Payer: BCBS Complete |
$16.35
|
| Rate for Payer: BCBS MAPPO |
$29.05
|
| Rate for Payer: BCBS Trust/PPO |
$67.31
|
| Rate for Payer: BCN Commercial |
$63.72
|
| Rate for Payer: BCN Medicare Advantage |
$29.05
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cofinity Commercial |
$77.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.05
|
| Rate for Payer: Healthscope Commercial |
$82.19
|
| Rate for Payer: Healthscope Whirlpool |
$79.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.05
|
| Rate for Payer: Mclaren Commercial |
$73.97
|
| Rate for Payer: Mclaren Medicaid |
$15.57
|
| Rate for Payer: Mclaren Medicare |
$29.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.50
|
| Rate for Payer: Meridian Medicaid |
$16.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.86
|
| Rate for Payer: Nomi Health Commercial |
$67.40
|
| Rate for Payer: PACE Medicare |
$27.60
|
| Rate for Payer: PACE SWMI |
$29.05
|
| Rate for Payer: PHP Commercial |
$31.95
|
| Rate for Payer: PHP Medicaid |
$15.57
|
| Rate for Payer: PHP Medicare Advantage |
$29.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.01
|
| Rate for Payer: Priority Health Medicare |
$29.05
|
| Rate for Payer: Priority Health Narrow Network |
$57.62
|
| Rate for Payer: Railroad Medicare Medicare |
$29.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.05
|
| Rate for Payer: UHC Exchange |
$45.03
|
| Rate for Payer: UHC Medicare Advantage |
$29.05
|
| Rate for Payer: UHCCP DNSP |
$29.05
|
| Rate for Payer: UHCCP Medicaid |
$15.57
|
| Rate for Payer: VA VA |
$29.05
|
|
|
HC CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Facility
|
IP
|
$82.19
|
|
|
Service Code
|
CPT 99484
|
| Hospital Charge Code |
51000107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.42 |
| Max. Negotiated Rate |
$82.19 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| Rate for Payer: ASR ASR |
$79.72
|
| Rate for Payer: ASR Commercial |
$79.72
|
| Rate for Payer: BCBS Trust/PPO |
$66.98
|
| Rate for Payer: BCN Commercial |
$63.72
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cofinity Commercial |
$77.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.75
|
| Rate for Payer: Healthscope Commercial |
$82.19
|
| Rate for Payer: Healthscope Whirlpool |
$79.72
|
| Rate for Payer: Mclaren Commercial |
$73.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.86
|
| Rate for Payer: Nomi Health Commercial |
$67.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.33
|
|
|
HC CARNITINE
|
Facility
|
IP
|
$59.16
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
30100136
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$59.16 |
| Rate for Payer: Aetna Commercial |
$53.24
|
| Rate for Payer: ASR ASR |
$57.39
|
| Rate for Payer: ASR Commercial |
$57.39
|
| Rate for Payer: BCBS Trust/PPO |
$48.21
|
| Rate for Payer: BCN Commercial |
$45.87
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cofinity Commercial |
$55.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.33
|
| Rate for Payer: Healthscope Commercial |
$59.16
|
| Rate for Payer: Healthscope Whirlpool |
$57.39
|
| Rate for Payer: Mclaren Commercial |
$53.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.29
|
| Rate for Payer: Nomi Health Commercial |
$48.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.06
|
|
|
HC CARNITINE
|
Facility
|
OP
|
$59.16
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
30100136
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$59.16 |
| Rate for Payer: Aetna Commercial |
$53.24
|
| Rate for Payer: Aetna Medicare |
$16.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: ASR ASR |
$57.39
|
| Rate for Payer: ASR Commercial |
$57.39
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$48.45
|
| Rate for Payer: BCN Commercial |
$45.87
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cofinity Commercial |
$55.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$59.16
|
| Rate for Payer: Healthscope Whirlpool |
$57.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.87
|
| Rate for Payer: Mclaren Commercial |
$53.24
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.29
|
| Rate for Payer: Nomi Health Commercial |
$48.51
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Medicaid |
$9.04
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.84
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health Narrow Network |
$41.47
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.87
|
| Rate for Payer: UHC Exchange |
$26.15
|
| Rate for Payer: UHC Medicare Advantage |
$16.87
|
| Rate for Payer: UHCCP DNSP |
$16.87
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC CAR OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200010
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Trust/PPO |
$118.23
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC CAR OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200010
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$118.81
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.12
|
| Rate for Payer: Priority Health Narrow Network |
$101.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC CAROTENE
|
Facility
|
OP
|
$150.96
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
30100137
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Aetna Commercial |
$135.86
|
| Rate for Payer: Aetna Medicare |
$9.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.53
|
| Rate for Payer: ASR ASR |
$146.43
|
| Rate for Payer: ASR Commercial |
$146.43
|
| Rate for Payer: BCBS Complete |
$5.19
|
| Rate for Payer: BCBS MAPPO |
$9.22
|
| Rate for Payer: BCBS Trust/PPO |
$123.62
|
| Rate for Payer: BCN Commercial |
$117.04
|
| Rate for Payer: BCN Medicare Advantage |
$9.22
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.22
|
| Rate for Payer: Healthscope Commercial |
$150.96
|
| Rate for Payer: Healthscope Whirlpool |
$146.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.22
|
| Rate for Payer: Mclaren Commercial |
$135.86
|
| Rate for Payer: Mclaren Medicaid |
$4.94
|
| Rate for Payer: Mclaren Medicare |
$9.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.68
|
| Rate for Payer: Meridian Medicaid |
$5.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.32
|
| Rate for Payer: Nomi Health Commercial |
$123.79
|
| Rate for Payer: PACE Medicare |
$8.76
|
| Rate for Payer: PACE SWMI |
$9.22
|
| Rate for Payer: PHP Commercial |
$10.14
|
| Rate for Payer: PHP Medicaid |
$4.94
|
| Rate for Payer: PHP Medicare Advantage |
$9.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.27
|
| Rate for Payer: Priority Health Medicare |
$9.22
|
| Rate for Payer: Priority Health Narrow Network |
$105.82
|
| Rate for Payer: Railroad Medicare Medicare |
$9.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.22
|
| Rate for Payer: UHC Exchange |
$14.29
|
| Rate for Payer: UHC Medicare Advantage |
$9.22
|
| Rate for Payer: UHCCP DNSP |
$9.22
|
| Rate for Payer: UHCCP Medicaid |
$4.94
|
| Rate for Payer: VA VA |
$9.22
|
|
|
HC CAROTENE
|
Facility
|
IP
|
$150.96
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
30100137
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.12 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Aetna Commercial |
$135.86
|
| Rate for Payer: ASR ASR |
$146.43
|
| Rate for Payer: ASR Commercial |
$146.43
|
| Rate for Payer: BCBS Trust/PPO |
$123.02
|
| Rate for Payer: BCN Commercial |
$117.04
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Healthscope Commercial |
$150.96
|
| Rate for Payer: Healthscope Whirlpool |
$146.43
|
| Rate for Payer: Mclaren Commercial |
$135.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.32
|
| Rate for Payer: Nomi Health Commercial |
$123.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.84
|
|
|
HC CAROTID/VERTEBRAL LIMITED
|
Facility
|
OP
|
$726.53
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
40200054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$726.53 |
| Rate for Payer: Aetna Commercial |
$653.88
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$704.73
|
| Rate for Payer: ASR Commercial |
$704.73
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$594.96
|
| Rate for Payer: BCN Commercial |
$563.28
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$581.22
|
| Rate for Payer: Cash Price |
$581.22
|
| Rate for Payer: Cofinity Commercial |
$682.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$726.53
|
| Rate for Payer: Healthscope Whirlpool |
$704.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$653.88
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.55
|
| Rate for Payer: Nomi Health Commercial |
$595.75
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.59
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$509.30
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$639.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC CAROTID/VERTEBRAL LIMITED
|
Facility
|
IP
|
$726.53
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
40200054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$472.24 |
| Max. Negotiated Rate |
$726.53 |
| Rate for Payer: Aetna Commercial |
$653.88
|
| Rate for Payer: ASR ASR |
$704.73
|
| Rate for Payer: ASR Commercial |
$704.73
|
| Rate for Payer: BCBS Trust/PPO |
$592.05
|
| Rate for Payer: BCN Commercial |
$563.28
|
| Rate for Payer: Cash Price |
$581.22
|
| Rate for Payer: Cofinity Commercial |
$682.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.22
|
| Rate for Payer: Healthscope Commercial |
$726.53
|
| Rate for Payer: Healthscope Whirlpool |
$704.73
|
| Rate for Payer: Mclaren Commercial |
$653.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.55
|
| Rate for Payer: Nomi Health Commercial |
$595.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$639.35
|
|
|
HC CAROTID/VERTEBRAL ULTRASOUND
|
Facility
|
OP
|
$1,382.09
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
92100001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,382.09 |
| Rate for Payer: Aetna Commercial |
$1,243.88
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$1,340.63
|
| Rate for Payer: ASR Commercial |
$1,340.63
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.79
|
| Rate for Payer: BCN Commercial |
$1,071.53
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,105.67
|
| Rate for Payer: Cash Price |
$1,105.67
|
| Rate for Payer: Cofinity Commercial |
$1,299.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,105.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,382.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,340.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$1,243.88
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,174.78
|
| Rate for Payer: Nomi Health Commercial |
$1,133.31
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$898.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,210.99
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$968.85
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,216.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
