|
HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
91400003
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$77.52 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Medicare |
$141.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.15
|
| Rate for Payer: ASR ASR |
$218.25
|
| Rate for Payer: BCBS Complete |
$81.40
|
| Rate for Payer: BCBS MAPPO |
$141.72
|
| Rate for Payer: BCBS Trust/PPO |
$174.44
|
| Rate for Payer: BCN Commercial |
$174.44
|
| Rate for Payer: BCN Medicare Advantage |
$141.72
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$211.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.72
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Healthscope Whirlpool |
$218.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$141.72
|
| Rate for Payer: Mclaren Commercial |
$202.50
|
| Rate for Payer: Mclaren Medicaid |
$77.52
|
| Rate for Payer: Mclaren Medicare |
$141.72
|
| Rate for Payer: Meridian Medicaid |
$81.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PACE Medicare |
$134.63
|
| Rate for Payer: PACE SWMI |
$141.72
|
| Rate for Payer: PHP Commercial |
$155.89
|
| Rate for Payer: PHP Medicaid |
$77.52
|
| Rate for Payer: PHP Medicare Advantage |
$141.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.87
|
| Rate for Payer: Priority Health Medicare |
$141.72
|
| Rate for Payer: Priority Health Narrow Network |
$94.30
|
| Rate for Payer: Railroad Medicare Medicare |
$141.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.00
|
| Rate for Payer: UHC Medicare Advantage |
$145.97
|
| Rate for Payer: VA VA |
$141.72
|
|
|
HC PTCA ADD/BRANCH
|
Facility
|
IP
|
$7,147.66
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,003.36 |
| Max. Negotiated Rate |
$7,147.66 |
| Rate for Payer: Aetna Commercial |
$6,432.89
|
| Rate for Payer: ASR ASR |
$6,933.23
|
| Rate for Payer: BCBS Trust/PPO |
$5,541.58
|
| Rate for Payer: BCN Commercial |
$5,541.58
|
| Rate for Payer: Cash Price |
$5,718.13
|
| Rate for Payer: Cofinity Commercial |
$6,718.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,718.13
|
| Rate for Payer: Healthscope Commercial |
$7,147.66
|
| Rate for Payer: Healthscope Whirlpool |
$6,933.23
|
| Rate for Payer: Mclaren Commercial |
$6,432.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,075.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,003.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,289.94
|
|
|
HC PTCA ADD/BRANCH
|
Facility
|
OP
|
$7,147.66
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,859.06 |
| Max. Negotiated Rate |
$7,147.66 |
| Rate for Payer: Aetna Commercial |
$6,432.89
|
| Rate for Payer: ASR ASR |
$6,933.23
|
| Rate for Payer: BCBS Complete |
$2,859.06
|
| Rate for Payer: BCBS Trust/PPO |
$5,541.58
|
| Rate for Payer: BCN Commercial |
$5,541.58
|
| Rate for Payer: Cash Price |
$5,718.13
|
| Rate for Payer: Cash Price |
$5,718.13
|
| Rate for Payer: Cofinity Commercial |
$6,718.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,718.13
|
| Rate for Payer: Healthscope Commercial |
$7,147.66
|
| Rate for Payer: Healthscope Whirlpool |
$6,933.23
|
| Rate for Payer: Mclaren Commercial |
$6,432.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,075.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,003.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,304.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,443.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,289.94
|
|
|
HC PTCA BALLOON
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.40 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Aetna Commercial |
$918.90
|
| Rate for Payer: ASR ASR |
$990.37
|
| Rate for Payer: BCBS Complete |
$408.40
|
| Rate for Payer: BCBS Trust/PPO |
$791.58
|
| Rate for Payer: BCN Commercial |
$791.58
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cofinity Commercial |
$959.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.80
|
| Rate for Payer: Healthscope Commercial |
$1,021.00
|
| Rate for Payer: Healthscope Whirlpool |
$990.37
|
| Rate for Payer: Mclaren Commercial |
$918.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$929.11
|
| Rate for Payer: Priority Health Narrow Network |
$724.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.48
|
|
|
HC PTCA BALLOON
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$714.70 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Aetna Commercial |
$918.90
|
| Rate for Payer: ASR ASR |
$990.37
|
| Rate for Payer: BCBS Trust/PPO |
$791.58
|
| Rate for Payer: BCN Commercial |
$791.58
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cofinity Commercial |
$959.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.80
|
| Rate for Payer: Healthscope Commercial |
$1,021.00
|
| Rate for Payer: Healthscope Whirlpool |
$990.37
|
| Rate for Payer: Mclaren Commercial |
$918.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.48
|
|
|
HC PTCA VESSEL/BRANCH
|
Facility
|
OP
|
$10,980.15
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,779.05 |
| Max. Negotiated Rate |
$10,980.15 |
| Rate for Payer: Aetna Commercial |
$9,882.14
|
| Rate for Payer: Aetna Medicare |
$5,080.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,350.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,350.66
|
| Rate for Payer: ASR ASR |
$10,650.75
|
| Rate for Payer: BCBS Complete |
$2,918.26
|
| Rate for Payer: BCBS MAPPO |
$5,080.53
|
| Rate for Payer: BCBS Trust/PPO |
$8,512.91
|
| Rate for Payer: BCN Commercial |
$8,512.91
|
| Rate for Payer: BCN Medicare Advantage |
$5,080.53
|
| Rate for Payer: Cash Price |
$8,784.12
|
| Rate for Payer: Cash Price |
$8,784.12
|
| Rate for Payer: Cofinity Commercial |
$10,321.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,784.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,080.53
|
| Rate for Payer: Healthscope Commercial |
$10,980.15
|
| Rate for Payer: Healthscope Whirlpool |
$10,650.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,080.53
|
| Rate for Payer: Mclaren Commercial |
$9,882.14
|
| Rate for Payer: Mclaren Medicaid |
$2,779.05
|
| Rate for Payer: Mclaren Medicare |
$5,080.53
|
| Rate for Payer: Meridian Medicaid |
$2,918.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,334.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,842.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,333.13
|
| Rate for Payer: PACE Medicare |
$4,826.50
|
| Rate for Payer: PACE SWMI |
$5,080.53
|
| Rate for Payer: PHP Commercial |
$5,588.58
|
| Rate for Payer: PHP Medicaid |
$2,779.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,080.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,779.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,686.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,304.66
|
| Rate for Payer: Priority Health Medicare |
$5,080.53
|
| Rate for Payer: Priority Health Narrow Network |
$3,443.73
|
| Rate for Payer: Railroad Medicare Medicare |
$5,080.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,662.53
|
| Rate for Payer: UHC Medicare Advantage |
$5,232.95
|
| Rate for Payer: VA VA |
$5,080.53
|
|
|
HC PTCA VESSEL/BRANCH
|
Facility
|
IP
|
$10,980.15
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,686.10 |
| Max. Negotiated Rate |
$10,980.15 |
| Rate for Payer: Aetna Commercial |
$9,882.14
|
| Rate for Payer: ASR ASR |
$10,650.75
|
| Rate for Payer: BCBS Trust/PPO |
$8,512.91
|
| Rate for Payer: BCN Commercial |
$8,512.91
|
| Rate for Payer: Cash Price |
$8,784.12
|
| Rate for Payer: Cofinity Commercial |
$10,321.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,784.12
|
| Rate for Payer: Healthscope Commercial |
$10,980.15
|
| Rate for Payer: Healthscope Whirlpool |
$10,650.75
|
| Rate for Payer: Mclaren Commercial |
$9,882.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,333.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,686.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,662.53
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
OP
|
$18,727.35
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,645.28 |
| Max. Negotiated Rate |
$18,727.35 |
| Rate for Payer: Aetna Commercial |
$16,854.62
|
| Rate for Payer: ASR ASR |
$18,165.53
|
| Rate for Payer: BCBS Complete |
$7,490.94
|
| Rate for Payer: BCBS Trust/PPO |
$14,519.31
|
| Rate for Payer: BCN Commercial |
$14,519.31
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$17,603.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Healthscope Commercial |
$18,727.35
|
| Rate for Payer: Healthscope Whirlpool |
$18,165.53
|
| Rate for Payer: Mclaren Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,306.60
|
| Rate for Payer: Priority Health Narrow Network |
$6,645.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,480.07
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
IP
|
$18,727.35
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,109.14 |
| Max. Negotiated Rate |
$18,727.35 |
| Rate for Payer: Aetna Commercial |
$16,854.62
|
| Rate for Payer: ASR ASR |
$18,165.53
|
| Rate for Payer: BCBS Trust/PPO |
$14,519.31
|
| Rate for Payer: BCN Commercial |
$14,519.31
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$17,603.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Healthscope Commercial |
$18,727.35
|
| Rate for Payer: Healthscope Whirlpool |
$18,165.53
|
| Rate for Payer: Mclaren Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,480.07
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
IP
|
$28,586.86
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$20,010.80 |
| Max. Negotiated Rate |
$28,586.86 |
| Rate for Payer: Aetna Commercial |
$25,728.17
|
| Rate for Payer: ASR ASR |
$27,729.25
|
| Rate for Payer: BCBS Trust/PPO |
$22,163.39
|
| Rate for Payer: BCN Commercial |
$22,163.39
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$26,871.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,869.49
|
| Rate for Payer: Healthscope Commercial |
$28,586.86
|
| Rate for Payer: Healthscope Whirlpool |
$27,729.25
|
| Rate for Payer: Mclaren Commercial |
$25,728.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,156.44
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
OP
|
$28,586.86
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,645.28 |
| Max. Negotiated Rate |
$28,586.86 |
| Rate for Payer: Aetna Commercial |
$25,728.17
|
| Rate for Payer: Aetna Medicare |
$15,586.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,483.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,483.22
|
| Rate for Payer: ASR ASR |
$27,729.25
|
| Rate for Payer: BCBS Complete |
$8,952.93
|
| Rate for Payer: BCBS MAPPO |
$15,586.58
|
| Rate for Payer: BCBS Trust/PPO |
$22,163.39
|
| Rate for Payer: BCN Commercial |
$22,163.39
|
| Rate for Payer: BCN Medicare Advantage |
$15,586.58
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$26,871.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,869.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,586.58
|
| Rate for Payer: Healthscope Commercial |
$28,586.86
|
| Rate for Payer: Healthscope Whirlpool |
$27,729.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,586.58
|
| Rate for Payer: Mclaren Commercial |
$25,728.17
|
| Rate for Payer: Mclaren Medicaid |
$8,525.86
|
| Rate for Payer: Mclaren Medicare |
$15,586.58
|
| Rate for Payer: Meridian Medicaid |
$8,952.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,365.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,924.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PACE Medicare |
$14,807.25
|
| Rate for Payer: PACE SWMI |
$15,586.58
|
| Rate for Payer: PHP Commercial |
$17,145.24
|
| Rate for Payer: PHP Medicaid |
$8,525.86
|
| Rate for Payer: PHP Medicare Advantage |
$15,586.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,525.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,306.60
|
| Rate for Payer: Priority Health Medicare |
$15,586.58
|
| Rate for Payer: Priority Health Narrow Network |
$6,645.28
|
| Rate for Payer: Railroad Medicare Medicare |
$15,586.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,156.44
|
| Rate for Payer: UHC Medicare Advantage |
$16,054.18
|
| Rate for Payer: VA VA |
$15,586.58
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
IP
|
$11,706.18
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,194.33 |
| Max. Negotiated Rate |
$11,706.18 |
| Rate for Payer: Aetna Commercial |
$10,535.56
|
| Rate for Payer: ASR ASR |
$11,354.99
|
| Rate for Payer: BCBS Trust/PPO |
$9,075.80
|
| Rate for Payer: BCN Commercial |
$9,075.80
|
| Rate for Payer: Cash Price |
$9,364.94
|
| Rate for Payer: Cofinity Commercial |
$11,003.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,364.94
|
| Rate for Payer: Healthscope Commercial |
$11,706.18
|
| Rate for Payer: Healthscope Whirlpool |
$11,354.99
|
| Rate for Payer: Mclaren Commercial |
$10,535.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,950.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,194.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,301.44
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
OP
|
$11,706.18
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,682.47 |
| Max. Negotiated Rate |
$11,706.18 |
| Rate for Payer: Aetna Commercial |
$10,535.56
|
| Rate for Payer: ASR ASR |
$11,354.99
|
| Rate for Payer: BCBS Complete |
$4,682.47
|
| Rate for Payer: BCBS Trust/PPO |
$9,075.80
|
| Rate for Payer: BCN Commercial |
$9,075.80
|
| Rate for Payer: Cash Price |
$9,364.94
|
| Rate for Payer: Cash Price |
$9,364.94
|
| Rate for Payer: Cofinity Commercial |
$11,003.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,364.94
|
| Rate for Payer: Healthscope Commercial |
$11,706.18
|
| Rate for Payer: Healthscope Whirlpool |
$11,354.99
|
| Rate for Payer: Mclaren Commercial |
$10,535.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,950.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,194.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,208.16
|
| Rate for Payer: Priority Health Narrow Network |
$6,566.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,301.44
|
|
|
HC PTCRAWPTCA VES/BRANCH
|
Facility
|
OP
|
$15,389.41
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,348.94 |
| Max. Negotiated Rate |
$15,389.41 |
| Rate for Payer: Aetna Commercial |
$13,850.47
|
| Rate for Payer: Aetna Medicare |
$9,778.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: ASR ASR |
$14,927.73
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$11,931.41
|
| Rate for Payer: BCN Commercial |
$11,931.41
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$12,311.53
|
| Rate for Payer: Cash Price |
$12,311.53
|
| Rate for Payer: Cofinity Commercial |
$14,466.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,311.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$15,389.41
|
| Rate for Payer: Healthscope Whirlpool |
$14,927.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,778.69
|
| Rate for Payer: Mclaren Commercial |
$13,850.47
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,081.00
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Commercial |
$10,756.56
|
| Rate for Payer: PHP Medicaid |
$5,348.94
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,772.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,208.16
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$6,566.53
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,542.68
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
HC PTCRAWPTCA VES/BRANCH
|
Facility
|
IP
|
$15,389.41
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,772.59 |
| Max. Negotiated Rate |
$15,389.41 |
| Rate for Payer: Aetna Commercial |
$13,850.47
|
| Rate for Payer: ASR ASR |
$14,927.73
|
| Rate for Payer: BCBS Trust/PPO |
$11,931.41
|
| Rate for Payer: BCN Commercial |
$11,931.41
|
| Rate for Payer: Cash Price |
$12,311.53
|
| Rate for Payer: Cofinity Commercial |
$14,466.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,311.53
|
| Rate for Payer: Healthscope Commercial |
$15,389.41
|
| Rate for Payer: Healthscope Whirlpool |
$14,927.73
|
| Rate for Payer: Mclaren Commercial |
$13,850.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,081.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,772.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,542.68
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
IP
|
$18,727.35
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,109.14 |
| Max. Negotiated Rate |
$18,727.35 |
| Rate for Payer: Aetna Commercial |
$16,854.62
|
| Rate for Payer: ASR ASR |
$18,165.53
|
| Rate for Payer: BCBS Trust/PPO |
$14,519.31
|
| Rate for Payer: BCN Commercial |
$14,519.31
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$17,603.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Healthscope Commercial |
$18,727.35
|
| Rate for Payer: Healthscope Whirlpool |
$18,165.53
|
| Rate for Payer: Mclaren Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,480.07
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
OP
|
$18,727.35
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,230.54 |
| Max. Negotiated Rate |
$18,727.35 |
| Rate for Payer: Aetna Commercial |
$16,854.62
|
| Rate for Payer: ASR ASR |
$18,165.53
|
| Rate for Payer: BCBS Complete |
$7,490.94
|
| Rate for Payer: BCBS Trust/PPO |
$14,519.31
|
| Rate for Payer: BCN Commercial |
$14,519.31
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$17,603.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Healthscope Commercial |
$18,727.35
|
| Rate for Payer: Healthscope Whirlpool |
$18,165.53
|
| Rate for Payer: Mclaren Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.17
|
| Rate for Payer: Priority Health Narrow Network |
$5,230.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,480.07
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
OP
|
$28,586.86
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,230.54 |
| Max. Negotiated Rate |
$28,586.86 |
| Rate for Payer: Aetna Commercial |
$25,728.17
|
| Rate for Payer: Aetna Medicare |
$15,586.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,483.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,483.22
|
| Rate for Payer: ASR ASR |
$27,729.25
|
| Rate for Payer: BCBS Complete |
$8,952.93
|
| Rate for Payer: BCBS MAPPO |
$15,586.58
|
| Rate for Payer: BCBS Trust/PPO |
$22,163.39
|
| Rate for Payer: BCN Commercial |
$22,163.39
|
| Rate for Payer: BCN Medicare Advantage |
$15,586.58
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$26,871.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,869.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,586.58
|
| Rate for Payer: Healthscope Commercial |
$28,586.86
|
| Rate for Payer: Healthscope Whirlpool |
$27,729.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,586.58
|
| Rate for Payer: Mclaren Commercial |
$25,728.17
|
| Rate for Payer: Mclaren Medicaid |
$8,525.86
|
| Rate for Payer: Mclaren Medicare |
$15,586.58
|
| Rate for Payer: Meridian Medicaid |
$8,952.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,365.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,924.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PACE Medicare |
$14,807.25
|
| Rate for Payer: PACE SWMI |
$15,586.58
|
| Rate for Payer: PHP Commercial |
$17,145.24
|
| Rate for Payer: PHP Medicaid |
$8,525.86
|
| Rate for Payer: PHP Medicare Advantage |
$15,586.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,525.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.17
|
| Rate for Payer: Priority Health Medicare |
$15,586.58
|
| Rate for Payer: Priority Health Narrow Network |
$5,230.54
|
| Rate for Payer: Railroad Medicare Medicare |
$15,586.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,156.44
|
| Rate for Payer: UHC Medicare Advantage |
$16,054.18
|
| Rate for Payer: VA VA |
$15,586.58
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
IP
|
$28,586.86
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$20,010.80 |
| Max. Negotiated Rate |
$28,586.86 |
| Rate for Payer: Aetna Commercial |
$25,728.17
|
| Rate for Payer: ASR ASR |
$27,729.25
|
| Rate for Payer: BCBS Trust/PPO |
$22,163.39
|
| Rate for Payer: BCN Commercial |
$22,163.39
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$26,871.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,869.49
|
| Rate for Payer: Healthscope Commercial |
$28,586.86
|
| Rate for Payer: Healthscope Whirlpool |
$27,729.25
|
| Rate for Payer: Mclaren Commercial |
$25,728.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,156.44
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$308.55
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$215.98 |
| Max. Negotiated Rate |
$308.55 |
| Rate for Payer: Aetna Commercial |
$277.70
|
| Rate for Payer: ASR ASR |
$299.29
|
| Rate for Payer: BCBS Trust/PPO |
$239.22
|
| Rate for Payer: BCN Commercial |
$239.22
|
| Rate for Payer: Cash Price |
$246.84
|
| Rate for Payer: Cofinity Commercial |
$290.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.84
|
| Rate for Payer: Healthscope Commercial |
$308.55
|
| Rate for Payer: Healthscope Whirlpool |
$299.29
|
| Rate for Payer: Mclaren Commercial |
$277.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.52
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$308.55
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$123.42 |
| Max. Negotiated Rate |
$308.55 |
| Rate for Payer: Aetna Commercial |
$277.70
|
| Rate for Payer: ASR ASR |
$299.29
|
| Rate for Payer: BCBS Complete |
$123.42
|
| Rate for Payer: BCBS Trust/PPO |
$239.22
|
| Rate for Payer: BCN Commercial |
$239.22
|
| Rate for Payer: Cash Price |
$246.84
|
| Rate for Payer: Cofinity Commercial |
$290.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.84
|
| Rate for Payer: Healthscope Commercial |
$308.55
|
| Rate for Payer: Healthscope Whirlpool |
$299.29
|
| Rate for Payer: Mclaren Commercial |
$277.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.78
|
| Rate for Payer: Priority Health Narrow Network |
$219.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.52
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$252.45
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.98 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$227.20
|
| Rate for Payer: ASR ASR |
$244.88
|
| Rate for Payer: BCBS Complete |
$100.98
|
| Rate for Payer: BCBS Trust/PPO |
$195.72
|
| Rate for Payer: BCN Commercial |
$195.72
|
| Rate for Payer: Cash Price |
$201.96
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.96
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Healthscope Whirlpool |
$244.88
|
| Rate for Payer: Mclaren Commercial |
$227.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.73
|
| Rate for Payer: Priority Health Narrow Network |
$179.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.16
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$252.45
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$227.20
|
| Rate for Payer: ASR ASR |
$244.88
|
| Rate for Payer: BCBS Trust/PPO |
$195.72
|
| Rate for Payer: BCN Commercial |
$195.72
|
| Rate for Payer: Cash Price |
$201.96
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.96
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Healthscope Whirlpool |
$244.88
|
| Rate for Payer: Mclaren Commercial |
$227.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.16
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: BCBS Trust/PPO |
$217.47
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$217.47
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.26
|
| Rate for Payer: Priority Health Narrow Network |
$199.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
