|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$9,547.08
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,205.60 |
| Max. Negotiated Rate |
$9,547.08 |
| Rate for Payer: Aetna Commercial |
$8,592.37
|
| Rate for Payer: ASR ASR |
$9,260.67
|
| Rate for Payer: ASR Commercial |
$9,260.67
|
| Rate for Payer: BCBS Trust/PPO |
$7,779.92
|
| Rate for Payer: BCN Commercial |
$7,401.85
|
| Rate for Payer: Cash Price |
$7,637.66
|
| Rate for Payer: Cofinity Commercial |
$8,974.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,637.66
|
| Rate for Payer: Healthscope Commercial |
$9,547.08
|
| Rate for Payer: Healthscope Whirlpool |
$9,260.67
|
| Rate for Payer: Mclaren Commercial |
$8,592.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,115.02
|
| Rate for Payer: Nomi Health Commercial |
$7,828.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,205.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,401.43
|
|
|
HC NONSTRESS TEST
|
Facility
|
IP
|
$352.44
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$229.09 |
| Max. Negotiated Rate |
$352.44 |
| Rate for Payer: Aetna Commercial |
$317.20
|
| Rate for Payer: ASR ASR |
$341.87
|
| Rate for Payer: ASR Commercial |
$341.87
|
| Rate for Payer: BCBS Trust/PPO |
$287.20
|
| Rate for Payer: BCN Commercial |
$273.25
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cofinity Commercial |
$331.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.95
|
| Rate for Payer: Healthscope Commercial |
$352.44
|
| Rate for Payer: Healthscope Whirlpool |
$341.87
|
| Rate for Payer: Mclaren Commercial |
$317.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.57
|
| Rate for Payer: Nomi Health Commercial |
$289.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.15
|
|
|
HC NONSTRESS TEST
|
Facility
|
OP
|
$352.44
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$352.44 |
| Rate for Payer: Aetna Commercial |
$317.20
|
| Rate for Payer: Aetna Medicare |
$196.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: ASR ASR |
$341.87
|
| Rate for Payer: ASR Commercial |
$341.87
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCBS Trust/PPO |
$288.61
|
| Rate for Payer: BCN Commercial |
$273.25
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cofinity Commercial |
$331.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$352.44
|
| Rate for Payer: Healthscope Whirlpool |
$341.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$196.20
|
| Rate for Payer: Mclaren Commercial |
$317.20
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.57
|
| Rate for Payer: Nomi Health Commercial |
$289.00
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$215.82
|
| Rate for Payer: PHP Medicaid |
$105.16
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.81
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health Narrow Network |
$247.06
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$304.11
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP DNSP |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$105.16
|
| Rate for Payer: VA VA |
$196.20
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
IP
|
$3,312.08
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,152.85 |
| Max. Negotiated Rate |
$3,312.08 |
| Rate for Payer: Aetna Commercial |
$2,980.87
|
| Rate for Payer: ASR ASR |
$3,212.72
|
| Rate for Payer: ASR Commercial |
$3,212.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,699.01
|
| Rate for Payer: BCN Commercial |
$2,567.86
|
| Rate for Payer: Cash Price |
$2,649.66
|
| Rate for Payer: Cofinity Commercial |
$3,113.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,649.66
|
| Rate for Payer: Healthscope Commercial |
$3,312.08
|
| Rate for Payer: Healthscope Whirlpool |
$3,212.72
|
| Rate for Payer: Mclaren Commercial |
$2,980.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.27
|
| Rate for Payer: Nomi Health Commercial |
$2,715.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,152.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,914.63
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
OP
|
$3,312.08
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,324.83 |
| Max. Negotiated Rate |
$3,312.08 |
| Rate for Payer: Aetna Commercial |
$2,980.87
|
| Rate for Payer: Aetna Medicare |
$1,656.04
|
| Rate for Payer: ASR ASR |
$3,212.72
|
| Rate for Payer: ASR Commercial |
$3,212.72
|
| Rate for Payer: BCBS Complete |
$1,324.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,712.26
|
| Rate for Payer: BCN Commercial |
$2,567.86
|
| Rate for Payer: Cash Price |
$2,649.66
|
| Rate for Payer: Cofinity Commercial |
$3,113.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,649.66
|
| Rate for Payer: Healthscope Commercial |
$3,312.08
|
| Rate for Payer: Healthscope Whirlpool |
$3,212.72
|
| Rate for Payer: Mclaren Commercial |
$2,980.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.27
|
| Rate for Payer: Nomi Health Commercial |
$2,715.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,152.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,902.04
|
| Rate for Payer: Priority Health Narrow Network |
$2,321.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,914.63
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
IP
|
$4,516.48
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,935.71 |
| Max. Negotiated Rate |
$4,516.48 |
| Rate for Payer: Aetna Commercial |
$4,064.83
|
| Rate for Payer: ASR ASR |
$4,380.99
|
| Rate for Payer: ASR Commercial |
$4,380.99
|
| Rate for Payer: BCBS Trust/PPO |
$3,680.48
|
| Rate for Payer: BCN Commercial |
$3,501.63
|
| Rate for Payer: Cash Price |
$3,613.18
|
| Rate for Payer: Cofinity Commercial |
$4,245.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,613.18
|
| Rate for Payer: Healthscope Commercial |
$4,516.48
|
| Rate for Payer: Healthscope Whirlpool |
$4,380.99
|
| Rate for Payer: Mclaren Commercial |
$4,064.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,839.01
|
| Rate for Payer: Nomi Health Commercial |
$3,703.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,935.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,974.50
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
OP
|
$4,516.48
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,806.59 |
| Max. Negotiated Rate |
$4,516.48 |
| Rate for Payer: Aetna Commercial |
$4,064.83
|
| Rate for Payer: Aetna Medicare |
$2,258.24
|
| Rate for Payer: ASR ASR |
$4,380.99
|
| Rate for Payer: ASR Commercial |
$4,380.99
|
| Rate for Payer: BCBS Complete |
$1,806.59
|
| Rate for Payer: BCBS Trust/PPO |
$3,698.55
|
| Rate for Payer: BCN Commercial |
$3,501.63
|
| Rate for Payer: Cash Price |
$3,613.18
|
| Rate for Payer: Cofinity Commercial |
$4,245.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,613.18
|
| Rate for Payer: Healthscope Commercial |
$4,516.48
|
| Rate for Payer: Healthscope Whirlpool |
$4,380.99
|
| Rate for Payer: Mclaren Commercial |
$4,064.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,839.01
|
| Rate for Payer: Nomi Health Commercial |
$3,703.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,935.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,957.34
|
| Rate for Payer: Priority Health Narrow Network |
$3,166.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,974.50
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$22.47
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$24.22
|
| Rate for Payer: ASR Commercial |
$24.22
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$20.45
|
| Rate for Payer: BCN Commercial |
$19.36
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$23.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$24.97
|
| Rate for Payer: Healthscope Whirlpool |
$24.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$22.47
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.88
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$17.50
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$24.97 |
| Rate for Payer: Aetna Commercial |
$22.47
|
| Rate for Payer: ASR ASR |
$24.22
|
| Rate for Payer: ASR Commercial |
$24.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.35
|
| Rate for Payer: BCN Commercial |
$19.36
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$23.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$24.97
|
| Rate for Payer: Healthscope Whirlpool |
$24.22
|
| Rate for Payer: Mclaren Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.97
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$43.86 |
| Rate for Payer: Aetna Commercial |
$39.47
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: ASR ASR |
$42.54
|
| Rate for Payer: ASR Commercial |
$42.54
|
| Rate for Payer: BCBS Complete |
$17.54
|
| Rate for Payer: BCBS Trust/PPO |
$35.92
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$43.86
|
| Rate for Payer: Healthscope Whirlpool |
$42.54
|
| Rate for Payer: Mclaren Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Nomi Health Commercial |
$35.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.43
|
| Rate for Payer: Priority Health Narrow Network |
$30.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$43.86 |
| Rate for Payer: Aetna Commercial |
$39.47
|
| Rate for Payer: ASR ASR |
$42.54
|
| Rate for Payer: ASR Commercial |
$42.54
|
| Rate for Payer: BCBS Trust/PPO |
$35.74
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$43.86
|
| Rate for Payer: Healthscope Whirlpool |
$42.54
|
| Rate for Payer: Mclaren Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Nomi Health Commercial |
$35.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.60
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
IP
|
$414.53
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$269.44 |
| Max. Negotiated Rate |
$414.53 |
| Rate for Payer: Aetna Commercial |
$373.08
|
| Rate for Payer: ASR ASR |
$402.09
|
| Rate for Payer: ASR Commercial |
$402.09
|
| Rate for Payer: BCBS Trust/PPO |
$337.80
|
| Rate for Payer: BCN Commercial |
$321.39
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$389.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$414.53
|
| Rate for Payer: Healthscope Whirlpool |
$402.09
|
| Rate for Payer: Mclaren Commercial |
$373.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: Nomi Health Commercial |
$339.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.79
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
OP
|
$414.53
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.81 |
| Max. Negotiated Rate |
$414.53 |
| Rate for Payer: Aetna Commercial |
$373.08
|
| Rate for Payer: Aetna Medicare |
$207.26
|
| Rate for Payer: ASR ASR |
$402.09
|
| Rate for Payer: ASR Commercial |
$402.09
|
| Rate for Payer: BCBS Complete |
$165.81
|
| Rate for Payer: BCBS Trust/PPO |
$339.46
|
| Rate for Payer: BCN Commercial |
$321.39
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$389.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$414.53
|
| Rate for Payer: Healthscope Whirlpool |
$402.09
|
| Rate for Payer: Mclaren Commercial |
$373.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: Nomi Health Commercial |
$339.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.21
|
| Rate for Payer: Priority Health Narrow Network |
$290.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.79
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
IP
|
$948.26
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$616.37 |
| Max. Negotiated Rate |
$948.26 |
| Rate for Payer: Aetna Commercial |
$853.43
|
| Rate for Payer: ASR ASR |
$919.81
|
| Rate for Payer: ASR Commercial |
$919.81
|
| Rate for Payer: BCBS Trust/PPO |
$772.74
|
| Rate for Payer: BCN Commercial |
$735.19
|
| Rate for Payer: Cash Price |
$758.61
|
| Rate for Payer: Cofinity Commercial |
$891.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.61
|
| Rate for Payer: Healthscope Commercial |
$948.26
|
| Rate for Payer: Healthscope Whirlpool |
$919.81
|
| Rate for Payer: Mclaren Commercial |
$853.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.02
|
| Rate for Payer: Nomi Health Commercial |
$777.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$834.47
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
OP
|
$948.26
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$948.26 |
| Rate for Payer: Aetna Commercial |
$853.43
|
| 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 |
$919.81
|
| Rate for Payer: ASR Commercial |
$919.81
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$776.53
|
| Rate for Payer: BCN Commercial |
$735.19
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$758.61
|
| Rate for Payer: Cash Price |
$758.61
|
| Rate for Payer: Cofinity Commercial |
$891.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$948.26
|
| Rate for Payer: Healthscope Whirlpool |
$919.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$853.43
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.02
|
| Rate for Payer: Nomi Health Commercial |
$777.57
|
| 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 |
$616.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$830.87
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$664.73
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$834.47
|
| 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 NURSEMAID ELBOW REDUCTION
|
Facility
|
OP
|
$215.97
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$362.62 |
| Rate for Payer: Aetna Commercial |
$194.37
|
| Rate for Payer: Aetna Medicare |
$233.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: ASR ASR |
$209.49
|
| Rate for Payer: ASR Commercial |
$209.49
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCBS Trust/PPO |
$176.86
|
| Rate for Payer: BCN Commercial |
$167.44
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cofinity Commercial |
$203.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$215.97
|
| Rate for Payer: Healthscope Whirlpool |
$209.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$233.95
|
| Rate for Payer: Mclaren Commercial |
$194.37
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.57
|
| Rate for Payer: Nomi Health Commercial |
$177.10
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$257.35
|
| Rate for Payer: PHP Medicaid |
$125.40
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.23
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health Narrow Network |
$151.39
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Exchange |
$362.62
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP DNSP |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
IP
|
$215.97
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.38 |
| Max. Negotiated Rate |
$215.97 |
| Rate for Payer: Aetna Commercial |
$194.37
|
| Rate for Payer: ASR ASR |
$209.49
|
| Rate for Payer: ASR Commercial |
$209.49
|
| Rate for Payer: BCBS Trust/PPO |
$175.99
|
| Rate for Payer: BCN Commercial |
$167.44
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cofinity Commercial |
$203.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.78
|
| Rate for Payer: Healthscope Commercial |
$215.97
|
| Rate for Payer: Healthscope Whirlpool |
$209.49
|
| Rate for Payer: Mclaren Commercial |
$194.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.57
|
| Rate for Payer: Nomi Health Commercial |
$177.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.05
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$616.44
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$400.69 |
| Max. Negotiated Rate |
$616.44 |
| Rate for Payer: Aetna Commercial |
$554.80
|
| Rate for Payer: ASR ASR |
$597.95
|
| Rate for Payer: ASR Commercial |
$597.95
|
| Rate for Payer: BCBS Trust/PPO |
$502.34
|
| Rate for Payer: BCN Commercial |
$477.93
|
| Rate for Payer: Cash Price |
$493.15
|
| Rate for Payer: Cofinity Commercial |
$579.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.15
|
| Rate for Payer: Healthscope Commercial |
$616.44
|
| Rate for Payer: Healthscope Whirlpool |
$597.95
|
| Rate for Payer: Mclaren Commercial |
$554.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.97
|
| Rate for Payer: Nomi Health Commercial |
$505.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.47
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$616.44
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$246.58 |
| Max. Negotiated Rate |
$616.44 |
| Rate for Payer: Aetna Commercial |
$554.80
|
| Rate for Payer: Aetna Medicare |
$308.22
|
| Rate for Payer: ASR ASR |
$597.95
|
| Rate for Payer: ASR Commercial |
$597.95
|
| Rate for Payer: BCBS Complete |
$246.58
|
| Rate for Payer: BCBS Trust/PPO |
$504.80
|
| Rate for Payer: BCN Commercial |
$477.93
|
| Rate for Payer: Cash Price |
$493.15
|
| Rate for Payer: Cofinity Commercial |
$579.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.15
|
| Rate for Payer: Healthscope Commercial |
$616.44
|
| Rate for Payer: Healthscope Whirlpool |
$597.95
|
| Rate for Payer: Mclaren Commercial |
$554.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.97
|
| Rate for Payer: Nomi Health Commercial |
$505.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$540.12
|
| Rate for Payer: Priority Health Narrow Network |
$432.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.47
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
IP
|
$328.97
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$213.83 |
| Max. Negotiated Rate |
$328.97 |
| Rate for Payer: Aetna Commercial |
$296.07
|
| Rate for Payer: ASR ASR |
$319.10
|
| Rate for Payer: ASR Commercial |
$319.10
|
| Rate for Payer: BCBS Trust/PPO |
$268.08
|
| Rate for Payer: BCN Commercial |
$255.05
|
| Rate for Payer: Cash Price |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$309.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.18
|
| Rate for Payer: Healthscope Commercial |
$328.97
|
| Rate for Payer: Healthscope Whirlpool |
$319.10
|
| Rate for Payer: Mclaren Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.62
|
| Rate for Payer: Nomi Health Commercial |
$269.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.49
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
OP
|
$328.97
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$328.97 |
| Rate for Payer: Aetna Commercial |
$296.07
|
| Rate for Payer: Aetna Medicare |
$164.49
|
| Rate for Payer: ASR ASR |
$319.10
|
| Rate for Payer: ASR Commercial |
$319.10
|
| Rate for Payer: BCBS Complete |
$131.59
|
| Rate for Payer: BCBS Trust/PPO |
$269.39
|
| Rate for Payer: BCN Commercial |
$255.05
|
| Rate for Payer: Cash Price |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$309.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.18
|
| Rate for Payer: Healthscope Commercial |
$328.97
|
| Rate for Payer: Healthscope Whirlpool |
$319.10
|
| Rate for Payer: Mclaren Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.62
|
| Rate for Payer: Nomi Health Commercial |
$269.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.24
|
| Rate for Payer: Priority Health Narrow Network |
$230.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.49
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
OP
|
$308.88
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.55 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Medicare |
$154.44
|
| Rate for Payer: ASR ASR |
$299.61
|
| Rate for Payer: ASR Commercial |
$299.61
|
| Rate for Payer: BCBS Complete |
$123.55
|
| Rate for Payer: BCBS Trust/PPO |
$252.94
|
| Rate for Payer: BCN Commercial |
$239.47
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$290.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Healthscope Commercial |
$308.88
|
| Rate for Payer: Healthscope Whirlpool |
$299.61
|
| Rate for Payer: Mclaren Commercial |
$277.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.55
|
| Rate for Payer: Nomi Health Commercial |
$253.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.64
|
| Rate for Payer: Priority Health Narrow Network |
$216.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.81
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
IP
|
$308.88
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.77 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: ASR ASR |
$299.61
|
| Rate for Payer: ASR Commercial |
$299.61
|
| Rate for Payer: BCBS Trust/PPO |
$251.71
|
| Rate for Payer: BCN Commercial |
$239.47
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$290.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Healthscope Commercial |
$308.88
|
| Rate for Payer: Healthscope Whirlpool |
$299.61
|
| Rate for Payer: Mclaren Commercial |
$277.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.55
|
| Rate for Payer: Nomi Health Commercial |
$253.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.81
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
OP
|
$298.03
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.21 |
| Max. Negotiated Rate |
$298.03 |
| Rate for Payer: Aetna Commercial |
$268.23
|
| Rate for Payer: Aetna Medicare |
$149.01
|
| Rate for Payer: ASR ASR |
$289.09
|
| Rate for Payer: ASR Commercial |
$289.09
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: BCBS Trust/PPO |
$244.06
|
| Rate for Payer: BCN Commercial |
$231.06
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cofinity Commercial |
$280.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.42
|
| Rate for Payer: Healthscope Commercial |
$298.03
|
| Rate for Payer: Healthscope Whirlpool |
$289.09
|
| Rate for Payer: Mclaren Commercial |
$268.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.33
|
| Rate for Payer: Nomi Health Commercial |
$244.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.13
|
| Rate for Payer: Priority Health Narrow Network |
$208.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.27
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
IP
|
$298.03
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.72 |
| Max. Negotiated Rate |
$298.03 |
| Rate for Payer: Aetna Commercial |
$268.23
|
| Rate for Payer: ASR ASR |
$289.09
|
| Rate for Payer: ASR Commercial |
$289.09
|
| Rate for Payer: BCBS Trust/PPO |
$242.86
|
| Rate for Payer: BCN Commercial |
$231.06
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cofinity Commercial |
$280.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.42
|
| Rate for Payer: Healthscope Commercial |
$298.03
|
| Rate for Payer: Healthscope Whirlpool |
$289.09
|
| Rate for Payer: Mclaren Commercial |
$268.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.33
|
| Rate for Payer: Nomi Health Commercial |
$244.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.27
|
|
