|
HC PTCA VESSEL/BRANCH
|
Facility
|
OP
|
$11,199.75
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,994.22 |
| Max. Negotiated Rate |
$11,199.75 |
| Rate for Payer: Aetna Commercial |
$10,079.78
|
| Rate for Payer: Aetna Medicare |
$5,586.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,982.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,982.80
|
| Rate for Payer: ASR ASR |
$10,863.76
|
| Rate for Payer: ASR Commercial |
$10,863.76
|
| Rate for Payer: BCBS Complete |
$3,143.94
|
| Rate for Payer: BCBS MAPPO |
$5,586.24
|
| Rate for Payer: BCBS Trust/PPO |
$9,171.48
|
| Rate for Payer: BCN Commercial |
$8,683.17
|
| Rate for Payer: BCN Medicare Advantage |
$5,586.24
|
| Rate for Payer: Cash Price |
$8,959.80
|
| Rate for Payer: Cash Price |
$8,959.80
|
| Rate for Payer: Cofinity Commercial |
$10,527.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,959.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,586.24
|
| Rate for Payer: Healthscope Commercial |
$11,199.75
|
| Rate for Payer: Healthscope Whirlpool |
$10,863.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,586.24
|
| Rate for Payer: Mclaren Commercial |
$10,079.78
|
| Rate for Payer: Mclaren Medicaid |
$2,994.22
|
| Rate for Payer: Mclaren Medicare |
$5,586.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,865.55
|
| Rate for Payer: Meridian Medicaid |
$3,143.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,424.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,519.79
|
| Rate for Payer: Nomi Health Commercial |
$9,183.80
|
| Rate for Payer: PACE Medicare |
$5,306.93
|
| Rate for Payer: PACE SWMI |
$5,586.24
|
| Rate for Payer: PHP Commercial |
$6,144.86
|
| Rate for Payer: PHP Medicaid |
$2,994.22
|
| Rate for Payer: PHP Medicare Advantage |
$5,586.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,994.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,279.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,605.99
|
| Rate for Payer: Priority Health Medicare |
$5,586.24
|
| Rate for Payer: Priority Health Narrow Network |
$3,684.79
|
| Rate for Payer: Railroad Medicare Medicare |
$5,586.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,855.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,586.24
|
| Rate for Payer: UHC Exchange |
$8,658.67
|
| Rate for Payer: UHC Medicare Advantage |
$5,586.24
|
| Rate for Payer: UHCCP DNSP |
$5,586.24
|
| Rate for Payer: UHCCP Medicaid |
$2,994.22
|
| Rate for Payer: VA VA |
$5,586.24
|
|
|
HC PTCA VESSEL/BRANCH
|
Facility
|
IP
|
$11,199.75
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,279.84 |
| Max. Negotiated Rate |
$11,199.75 |
| Rate for Payer: Aetna Commercial |
$10,079.78
|
| Rate for Payer: ASR ASR |
$10,863.76
|
| Rate for Payer: ASR Commercial |
$10,863.76
|
| Rate for Payer: BCBS Trust/PPO |
$9,126.68
|
| Rate for Payer: BCN Commercial |
$8,683.17
|
| Rate for Payer: Cash Price |
$8,959.80
|
| Rate for Payer: Cofinity Commercial |
$10,527.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,959.80
|
| Rate for Payer: Healthscope Commercial |
$11,199.75
|
| Rate for Payer: Healthscope Whirlpool |
$10,863.76
|
| Rate for Payer: Mclaren Commercial |
$10,079.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,519.79
|
| Rate for Payer: Nomi Health Commercial |
$9,183.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,279.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,855.78
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
OP
|
$19,101.90
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,110.45 |
| Max. Negotiated Rate |
$19,101.90 |
| Rate for Payer: Aetna Commercial |
$17,191.71
|
| Rate for Payer: Aetna Medicare |
$9,550.95
|
| Rate for Payer: ASR ASR |
$18,528.84
|
| Rate for Payer: ASR Commercial |
$18,528.84
|
| Rate for Payer: BCBS Complete |
$7,640.76
|
| Rate for Payer: BCBS Trust/PPO |
$15,642.55
|
| Rate for Payer: BCN Commercial |
$14,809.70
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$17,955.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$19,101.90
|
| Rate for Payer: Healthscope Whirlpool |
$18,528.84
|
| Rate for Payer: Mclaren Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.62
|
| Rate for Payer: Nomi Health Commercial |
$15,663.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,888.06
|
| Rate for Payer: Priority Health Narrow Network |
$7,110.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,809.67
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
IP
|
$19,101.90
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,416.24 |
| Max. Negotiated Rate |
$19,101.90 |
| Rate for Payer: Aetna Commercial |
$17,191.71
|
| Rate for Payer: ASR ASR |
$18,528.84
|
| Rate for Payer: ASR Commercial |
$18,528.84
|
| Rate for Payer: BCBS Trust/PPO |
$15,566.14
|
| Rate for Payer: BCN Commercial |
$14,809.70
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$17,955.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$19,101.90
|
| Rate for Payer: Healthscope Whirlpool |
$18,528.84
|
| Rate for Payer: Mclaren Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.62
|
| Rate for Payer: Nomi Health Commercial |
$15,663.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,809.67
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
IP
|
$29,158.60
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,953.09 |
| Max. Negotiated Rate |
$29,158.60 |
| Rate for Payer: Aetna Commercial |
$26,242.74
|
| Rate for Payer: ASR ASR |
$28,283.84
|
| Rate for Payer: ASR Commercial |
$28,283.84
|
| Rate for Payer: BCBS Trust/PPO |
$23,761.34
|
| Rate for Payer: BCN Commercial |
$22,606.66
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$27,409.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Healthscope Commercial |
$29,158.60
|
| Rate for Payer: Healthscope Whirlpool |
$28,283.84
|
| Rate for Payer: Mclaren Commercial |
$26,242.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,910.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,659.57
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
OP
|
$29,158.60
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,110.45 |
| Max. Negotiated Rate |
$29,158.60 |
| Rate for Payer: Aetna Commercial |
$26,242.74
|
| Rate for Payer: Aetna Medicare |
$17,593.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: ASR ASR |
$28,283.84
|
| Rate for Payer: ASR Commercial |
$28,283.84
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$23,877.98
|
| Rate for Payer: BCN Commercial |
$22,606.66
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$27,409.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$29,158.60
|
| Rate for Payer: Healthscope Whirlpool |
$28,283.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,593.64
|
| Rate for Payer: Mclaren Commercial |
$26,242.74
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,910.05
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$19,353.00
|
| Rate for Payer: PHP Medicaid |
$9,430.19
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,888.06
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$7,110.45
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,659.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$27,270.14
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP DNSP |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
IP
|
$11,940.30
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,761.20 |
| Max. Negotiated Rate |
$11,940.30 |
| Rate for Payer: Aetna Commercial |
$10,746.27
|
| Rate for Payer: ASR ASR |
$11,582.09
|
| Rate for Payer: ASR Commercial |
$11,582.09
|
| Rate for Payer: BCBS Trust/PPO |
$9,730.15
|
| Rate for Payer: BCN Commercial |
$9,257.31
|
| Rate for Payer: Cash Price |
$9,552.24
|
| Rate for Payer: Cofinity Commercial |
$11,223.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,552.24
|
| Rate for Payer: Healthscope Commercial |
$11,940.30
|
| Rate for Payer: Healthscope Whirlpool |
$11,582.09
|
| Rate for Payer: Mclaren Commercial |
$10,746.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,149.26
|
| Rate for Payer: Nomi Health Commercial |
$9,791.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,761.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,507.46
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
OP
|
$11,940.30
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,776.12 |
| Max. Negotiated Rate |
$11,940.30 |
| Rate for Payer: Aetna Commercial |
$10,746.27
|
| Rate for Payer: Aetna Medicare |
$5,970.15
|
| Rate for Payer: ASR ASR |
$11,582.09
|
| Rate for Payer: ASR Commercial |
$11,582.09
|
| Rate for Payer: BCBS Complete |
$4,776.12
|
| Rate for Payer: BCBS Trust/PPO |
$9,777.91
|
| Rate for Payer: BCN Commercial |
$9,257.31
|
| Rate for Payer: Cash Price |
$9,552.24
|
| Rate for Payer: Cash Price |
$9,552.24
|
| Rate for Payer: Cofinity Commercial |
$11,223.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,552.24
|
| Rate for Payer: Healthscope Commercial |
$11,940.30
|
| Rate for Payer: Healthscope Whirlpool |
$11,582.09
|
| Rate for Payer: Mclaren Commercial |
$10,746.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,149.26
|
| Rate for Payer: Nomi Health Commercial |
$9,791.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,761.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,782.73
|
| Rate for Payer: Priority Health Narrow Network |
$7,026.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,507.46
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
IP
|
$19,101.90
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,416.24 |
| Max. Negotiated Rate |
$19,101.90 |
| Rate for Payer: Aetna Commercial |
$17,191.71
|
| Rate for Payer: ASR ASR |
$18,528.84
|
| Rate for Payer: ASR Commercial |
$18,528.84
|
| Rate for Payer: BCBS Trust/PPO |
$15,566.14
|
| Rate for Payer: BCN Commercial |
$14,809.70
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$17,955.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$19,101.90
|
| Rate for Payer: Healthscope Whirlpool |
$18,528.84
|
| Rate for Payer: Mclaren Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.62
|
| Rate for Payer: Nomi Health Commercial |
$15,663.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,809.67
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
OP
|
$19,101.90
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,596.67 |
| Max. Negotiated Rate |
$19,101.90 |
| Rate for Payer: Aetna Commercial |
$17,191.71
|
| Rate for Payer: Aetna Medicare |
$9,550.95
|
| Rate for Payer: ASR ASR |
$18,528.84
|
| Rate for Payer: ASR Commercial |
$18,528.84
|
| Rate for Payer: BCBS Complete |
$7,640.76
|
| Rate for Payer: BCBS Trust/PPO |
$15,642.55
|
| Rate for Payer: BCN Commercial |
$14,809.70
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$17,955.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$19,101.90
|
| Rate for Payer: Healthscope Whirlpool |
$18,528.84
|
| Rate for Payer: Mclaren Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.62
|
| Rate for Payer: Nomi Health Commercial |
$15,663.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,995.84
|
| Rate for Payer: Priority Health Narrow Network |
$5,596.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,809.67
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
IP
|
$29,158.60
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,953.09 |
| Max. Negotiated Rate |
$29,158.60 |
| Rate for Payer: Aetna Commercial |
$26,242.74
|
| Rate for Payer: ASR ASR |
$28,283.84
|
| Rate for Payer: ASR Commercial |
$28,283.84
|
| Rate for Payer: BCBS Trust/PPO |
$23,761.34
|
| Rate for Payer: BCN Commercial |
$22,606.66
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$27,409.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Healthscope Commercial |
$29,158.60
|
| Rate for Payer: Healthscope Whirlpool |
$28,283.84
|
| Rate for Payer: Mclaren Commercial |
$26,242.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,910.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,659.57
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
OP
|
$29,158.60
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,596.67 |
| Max. Negotiated Rate |
$29,158.60 |
| Rate for Payer: Aetna Commercial |
$26,242.74
|
| Rate for Payer: Aetna Medicare |
$17,593.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: ASR ASR |
$28,283.84
|
| Rate for Payer: ASR Commercial |
$28,283.84
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$23,877.98
|
| Rate for Payer: BCN Commercial |
$22,606.66
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$27,409.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$29,158.60
|
| Rate for Payer: Healthscope Whirlpool |
$28,283.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,593.64
|
| Rate for Payer: Mclaren Commercial |
$26,242.74
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,910.05
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$19,353.00
|
| Rate for Payer: PHP Medicaid |
$9,430.19
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,995.84
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$5,596.67
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,659.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$27,270.14
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP DNSP |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$314.72
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$125.89 |
| Max. Negotiated Rate |
$314.72 |
| Rate for Payer: Aetna Commercial |
$283.25
|
| Rate for Payer: Aetna Medicare |
$157.36
|
| Rate for Payer: ASR ASR |
$305.28
|
| Rate for Payer: ASR Commercial |
$305.28
|
| Rate for Payer: BCBS Complete |
$125.89
|
| Rate for Payer: BCBS Trust/PPO |
$257.72
|
| Rate for Payer: BCN Commercial |
$244.00
|
| Rate for Payer: Cash Price |
$251.78
|
| Rate for Payer: Cofinity Commercial |
$295.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.78
|
| Rate for Payer: Healthscope Commercial |
$314.72
|
| Rate for Payer: Healthscope Whirlpool |
$305.28
|
| Rate for Payer: Mclaren Commercial |
$283.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.51
|
| Rate for Payer: Nomi Health Commercial |
$258.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.76
|
| Rate for Payer: Priority Health Narrow Network |
$220.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.95
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$314.72
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$204.57 |
| Max. Negotiated Rate |
$314.72 |
| Rate for Payer: Aetna Commercial |
$283.25
|
| Rate for Payer: ASR ASR |
$305.28
|
| Rate for Payer: ASR Commercial |
$305.28
|
| Rate for Payer: BCBS Trust/PPO |
$256.47
|
| Rate for Payer: BCN Commercial |
$244.00
|
| Rate for Payer: Cash Price |
$251.78
|
| Rate for Payer: Cofinity Commercial |
$295.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.78
|
| Rate for Payer: Healthscope Commercial |
$314.72
|
| Rate for Payer: Healthscope Whirlpool |
$305.28
|
| Rate for Payer: Mclaren Commercial |
$283.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.51
|
| Rate for Payer: Nomi Health Commercial |
$258.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.95
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$257.50
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$167.38 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: ASR ASR |
$249.78
|
| Rate for Payer: ASR Commercial |
$249.78
|
| Rate for Payer: BCBS Trust/PPO |
$209.84
|
| Rate for Payer: BCN Commercial |
$199.64
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cofinity Commercial |
$242.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.00
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Healthscope Whirlpool |
$249.78
|
| Rate for Payer: Mclaren Commercial |
$231.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.88
|
| Rate for Payer: Nomi Health Commercial |
$211.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.60
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$257.50
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$128.75
|
| Rate for Payer: ASR ASR |
$249.78
|
| Rate for Payer: ASR Commercial |
$249.78
|
| Rate for Payer: BCBS Complete |
$103.00
|
| Rate for Payer: BCBS Trust/PPO |
$210.87
|
| Rate for Payer: BCN Commercial |
$199.64
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cofinity Commercial |
$242.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.00
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Healthscope Whirlpool |
$249.78
|
| Rate for Payer: Mclaren Commercial |
$231.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.88
|
| Rate for Payer: Nomi Health Commercial |
$211.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.62
|
| Rate for Payer: Priority Health Narrow Network |
$180.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.60
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: ASR Commercial |
$277.53
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$221.82
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$286.11
|
| Rate for Payer: Healthscope Whirlpool |
$277.53
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.69
|
| Rate for Payer: Priority Health Narrow Network |
$200.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$185.97 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: ASR Commercial |
$277.53
|
| Rate for Payer: BCBS Trust/PPO |
$233.15
|
| Rate for Payer: BCN Commercial |
$221.82
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$286.11
|
| Rate for Payer: Healthscope Whirlpool |
$277.53
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
HC PT MIX 1:1
|
Facility
|
OP
|
$70.44
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$70.44 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.92
|
| Rate for Payer: ASR ASR |
$68.33
|
| Rate for Payer: ASR Commercial |
$68.33
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$57.68
|
| Rate for Payer: BCN Commercial |
$54.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.94
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$70.44
|
| Rate for Payer: Healthscope Whirlpool |
$68.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.94
|
| Rate for Payer: Mclaren Commercial |
$63.40
|
| Rate for Payer: Mclaren Medicaid |
$2.11
|
| Rate for Payer: Mclaren Medicare |
$3.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.14
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.87
|
| Rate for Payer: Nomi Health Commercial |
$57.76
|
| Rate for Payer: PACE Medicare |
$3.74
|
| Rate for Payer: PACE SWMI |
$3.94
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: PHP Medicaid |
$2.11
|
| Rate for Payer: PHP Medicare Advantage |
$3.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.72
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: Priority Health Narrow Network |
$49.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.94
|
| Rate for Payer: UHC Exchange |
$6.11
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| Rate for Payer: UHCCP DNSP |
$3.94
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: VA VA |
$3.94
|
|
|
HC PT MIX 1:1
|
Facility
|
IP
|
$70.44
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$70.44 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: ASR ASR |
$68.33
|
| Rate for Payer: ASR Commercial |
$68.33
|
| Rate for Payer: BCBS Trust/PPO |
$57.40
|
| Rate for Payer: BCN Commercial |
$54.61
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.35
|
| Rate for Payer: Healthscope Commercial |
$70.44
|
| Rate for Payer: Healthscope Whirlpool |
$68.33
|
| Rate for Payer: Mclaren Commercial |
$63.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.87
|
| Rate for Payer: Nomi Health Commercial |
$57.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.99
|
|
|
HC PT NEUROSTIM
|
Facility
|
OP
|
$97.14
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.14 |
| Max. Negotiated Rate |
$97.14 |
| Rate for Payer: Aetna Commercial |
$87.43
|
| Rate for Payer: Aetna Medicare |
$48.57
|
| Rate for Payer: ASR ASR |
$94.23
|
| Rate for Payer: ASR Commercial |
$94.23
|
| Rate for Payer: BCBS Complete |
$38.86
|
| Rate for Payer: BCBS Trust/PPO |
$79.55
|
| Rate for Payer: BCN Commercial |
$75.31
|
| Rate for Payer: Cash Price |
$77.71
|
| Rate for Payer: Cash Price |
$77.71
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.71
|
| Rate for Payer: Healthscope Commercial |
$97.14
|
| Rate for Payer: Healthscope Whirlpool |
$94.23
|
| Rate for Payer: Mclaren Commercial |
$87.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.57
|
| Rate for Payer: Nomi Health Commercial |
$79.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.92
|
| Rate for Payer: Priority Health Narrow Network |
$35.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.48
|
|
|
HC PT NEUROSTIM
|
Facility
|
IP
|
$97.14
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.14 |
| Max. Negotiated Rate |
$97.14 |
| Rate for Payer: Aetna Commercial |
$87.43
|
| Rate for Payer: ASR ASR |
$94.23
|
| Rate for Payer: ASR Commercial |
$94.23
|
| Rate for Payer: BCBS Trust/PPO |
$79.16
|
| Rate for Payer: BCN Commercial |
$75.31
|
| Rate for Payer: Cash Price |
$77.71
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.71
|
| Rate for Payer: Healthscope Commercial |
$97.14
|
| Rate for Payer: Healthscope Whirlpool |
$94.23
|
| Rate for Payer: Mclaren Commercial |
$87.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.57
|
| Rate for Payer: Nomi Health Commercial |
$79.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.48
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$128.16
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$128.16 |
| Rate for Payer: Aetna Commercial |
$115.34
|
| Rate for Payer: ASR ASR |
$124.32
|
| Rate for Payer: ASR Commercial |
$124.32
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$99.36
|
| Rate for Payer: Cash Price |
$102.53
|
| Rate for Payer: Cofinity Commercial |
$120.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.53
|
| Rate for Payer: Healthscope Commercial |
$128.16
|
| Rate for Payer: Healthscope Whirlpool |
$124.32
|
| Rate for Payer: Mclaren Commercial |
$115.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.94
|
| Rate for Payer: Nomi Health Commercial |
$105.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.78
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$128.16
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$51.26 |
| Max. Negotiated Rate |
$128.16 |
| Rate for Payer: Aetna Commercial |
$115.34
|
| Rate for Payer: Aetna Medicare |
$64.08
|
| Rate for Payer: ASR ASR |
$124.32
|
| Rate for Payer: ASR Commercial |
$124.32
|
| Rate for Payer: BCBS Complete |
$51.26
|
| Rate for Payer: BCBS Trust/PPO |
$104.95
|
| Rate for Payer: BCN Commercial |
$99.36
|
| Rate for Payer: Cash Price |
$102.53
|
| Rate for Payer: Cofinity Commercial |
$120.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.53
|
| Rate for Payer: Healthscope Commercial |
$128.16
|
| Rate for Payer: Healthscope Whirlpool |
$124.32
|
| Rate for Payer: Mclaren Commercial |
$115.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.94
|
| Rate for Payer: Nomi Health Commercial |
$105.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.29
|
| Rate for Payer: Priority Health Narrow Network |
$89.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.78
|
|
|
HC PULM EXER FUNCTION INDIV 15 MIN
|
Facility
|
OP
|
$87.68
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
41000045
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$87.68 |
| Rate for Payer: Aetna Commercial |
$78.91
|
| Rate for Payer: Aetna Medicare |
$23.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.99
|
| Rate for Payer: ASR ASR |
$85.05
|
| Rate for Payer: ASR Commercial |
$85.05
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS MAPPO |
$23.99
|
| Rate for Payer: BCBS Trust/PPO |
$71.80
|
| Rate for Payer: BCN Commercial |
$67.98
|
| Rate for Payer: BCN Medicare Advantage |
$23.99
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$82.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.99
|
| Rate for Payer: Healthscope Commercial |
$87.68
|
| Rate for Payer: Healthscope Whirlpool |
$85.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.99
|
| Rate for Payer: Mclaren Commercial |
$78.91
|
| Rate for Payer: Mclaren Medicaid |
$12.86
|
| Rate for Payer: Mclaren Medicare |
$23.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.19
|
| Rate for Payer: Meridian Medicaid |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: PACE Medicare |
$22.79
|
| Rate for Payer: PACE SWMI |
$23.99
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: PHP Medicaid |
$12.86
|
| Rate for Payer: PHP Medicare Advantage |
$23.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.83
|
| Rate for Payer: Priority Health Medicare |
$23.99
|
| Rate for Payer: Priority Health Narrow Network |
$61.46
|
| Rate for Payer: Railroad Medicare Medicare |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.99
|
| Rate for Payer: UHC Exchange |
$37.18
|
| Rate for Payer: UHC Medicare Advantage |
$23.99
|
| Rate for Payer: UHCCP DNSP |
$23.99
|
| Rate for Payer: UHCCP Medicaid |
$12.86
|
| Rate for Payer: VA VA |
$23.99
|
|
