|
HC SEDATION IV / IM OR INHALANT
|
Facility
|
IP
|
$749.58
|
|
| Hospital Charge Code |
37000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$562.18 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Aetna Commercial |
$674.62
|
| Rate for Payer: ASR ASR |
$727.09
|
| Rate for Payer: BCBS Trust/PPO |
$615.56
|
| Rate for Payer: BCN Commercial |
$615.56
|
| Rate for Payer: Cash Price |
$599.66
|
| Rate for Payer: Cofinity Commercial |
$704.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$599.66
|
| Rate for Payer: Healthscope Commercial |
$727.09
|
| Rate for Payer: Healthscope Whirlpool |
$749.58
|
| Rate for Payer: Mclaren Commercial |
$674.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$637.14
|
| Rate for Payer: Nomi Health Commercial |
$614.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$562.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$659.63
|
|
|
HC SEDATION IV / IM OR INHALANT
|
Facility
|
OP
|
$749.58
|
|
| Hospital Charge Code |
37000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$277.34 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Aetna Commercial |
$674.62
|
| Rate for Payer: Aetna Medicare |
$277.34
|
| Rate for Payer: ASR ASR |
$727.09
|
| Rate for Payer: BCBS Complete |
$299.83
|
| Rate for Payer: BCBS Trust/PPO |
$618.03
|
| Rate for Payer: BCN Commercial |
$618.03
|
| Rate for Payer: Cash Price |
$599.66
|
| Rate for Payer: Cofinity Commercial |
$704.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$599.66
|
| Rate for Payer: Healthscope Commercial |
$727.09
|
| Rate for Payer: Healthscope Whirlpool |
$749.58
|
| Rate for Payer: Mclaren Commercial |
$674.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$599.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$637.14
|
| Rate for Payer: Nomi Health Commercial |
$614.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$562.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$656.78
|
| Rate for Payer: Priority Health Narrow Network |
$525.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$659.63
|
|
|
HC SED RATE WESTERGREN
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
30500060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna Commercial |
$14.33
|
| Rate for Payer: ASR ASR |
$15.44
|
| Rate for Payer: BCBS Trust/PPO |
$13.07
|
| Rate for Payer: BCN Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$15.44
|
| Rate for Payer: Healthscope Whirlpool |
$15.92
|
| Rate for Payer: Mclaren Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.01
|
|
|
HC SED RATE WESTERGREN
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
30500060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna Commercial |
$14.33
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.38
|
| Rate for Payer: ASR ASR |
$15.44
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS MAPPO |
$2.70
|
| Rate for Payer: BCBS Trust/PPO |
$13.13
|
| Rate for Payer: BCN Commercial |
$13.13
|
| Rate for Payer: BCN Medicare Advantage |
$2.70
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$15.44
|
| Rate for Payer: Healthscope Whirlpool |
$15.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.70
|
| Rate for Payer: Mclaren Commercial |
$14.33
|
| Rate for Payer: Mclaren Medicaid |
$2.70
|
| Rate for Payer: Mclaren Medicare |
$2.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.83
|
| Rate for Payer: Meridian Medicaid |
$1.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PACE Medicare |
$2.56
|
| Rate for Payer: PACE SWMI |
$2.70
|
| Rate for Payer: PHP Commercial |
$2.97
|
| Rate for Payer: PHP Medicaid |
$1.45
|
| Rate for Payer: PHP Medicare Advantage |
$2.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.95
|
| Rate for Payer: Priority Health Medicare |
$2.70
|
| Rate for Payer: Priority Health Narrow Network |
$11.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.70
|
| Rate for Payer: UHC Exchange |
$4.18
|
| Rate for Payer: UHC Medicaid |
$1.41
|
| Rate for Payer: UHCCP DNSP |
$2.70
|
| Rate for Payer: UHCCP Medicaid |
$1.41
|
| Rate for Payer: VA VA |
$2.70
|
|
|
HC SELECTIVE EACH INTRACRANIAL UNI
|
Facility
|
IP
|
$5,066.39
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
36100386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,799.79 |
| Max. Negotiated Rate |
$5,066.39 |
| Rate for Payer: Aetna Commercial |
$4,559.75
|
| Rate for Payer: ASR ASR |
$4,914.40
|
| Rate for Payer: BCBS Trust/PPO |
$4,160.52
|
| Rate for Payer: BCN Commercial |
$4,160.52
|
| Rate for Payer: Cash Price |
$4,053.11
|
| Rate for Payer: Cofinity Commercial |
$4,762.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,053.11
|
| Rate for Payer: Healthscope Commercial |
$4,914.40
|
| Rate for Payer: Healthscope Whirlpool |
$5,066.39
|
| Rate for Payer: Mclaren Commercial |
$4,559.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,306.43
|
| Rate for Payer: Nomi Health Commercial |
$4,154.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,799.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,458.42
|
|
|
HC SELECTIVE EACH INTRACRANIAL UNI
|
Facility
|
OP
|
$5,066.39
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
36100386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$5,066.39 |
| Rate for Payer: Aetna Commercial |
$4,559.75
|
| Rate for Payer: Aetna Medicare |
$1,874.56
|
| Rate for Payer: ASR ASR |
$4,914.40
|
| Rate for Payer: BCBS Complete |
$2,026.56
|
| Rate for Payer: BCBS Trust/PPO |
$4,177.24
|
| Rate for Payer: BCN Commercial |
$4,177.24
|
| Rate for Payer: Cash Price |
$4,053.11
|
| Rate for Payer: Cash Price |
$4,053.11
|
| Rate for Payer: Cofinity Commercial |
$4,762.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,053.11
|
| Rate for Payer: Healthscope Commercial |
$4,914.40
|
| Rate for Payer: Healthscope Whirlpool |
$5,066.39
|
| Rate for Payer: Mclaren Commercial |
$4,559.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,053.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,306.43
|
| Rate for Payer: Nomi Health Commercial |
$4,154.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,799.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,458.42
|
|
|
HC SELECTIVE EXTERNAL CAROTID UNI
|
Facility
|
OP
|
$5,861.23
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
36100382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$5,861.23 |
| Rate for Payer: Aetna Commercial |
$5,275.11
|
| Rate for Payer: Aetna Medicare |
$2,168.66
|
| Rate for Payer: ASR ASR |
$5,685.39
|
| Rate for Payer: BCBS Complete |
$2,344.49
|
| Rate for Payer: BCBS Trust/PPO |
$4,832.58
|
| Rate for Payer: BCN Commercial |
$4,832.58
|
| Rate for Payer: Cash Price |
$4,688.98
|
| Rate for Payer: Cash Price |
$4,688.98
|
| Rate for Payer: Cofinity Commercial |
$5,509.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,688.98
|
| Rate for Payer: Healthscope Commercial |
$5,685.39
|
| Rate for Payer: Healthscope Whirlpool |
$5,861.23
|
| Rate for Payer: Mclaren Commercial |
$5,275.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,688.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,982.05
|
| Rate for Payer: Nomi Health Commercial |
$4,806.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,395.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,157.88
|
|
|
HC SELECTIVE EXTERNAL CAROTID UNI
|
Facility
|
IP
|
$5,861.23
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
36100382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,395.92 |
| Max. Negotiated Rate |
$5,861.23 |
| Rate for Payer: Aetna Commercial |
$5,275.11
|
| Rate for Payer: ASR ASR |
$5,685.39
|
| Rate for Payer: BCBS Trust/PPO |
$4,813.24
|
| Rate for Payer: BCN Commercial |
$4,813.24
|
| Rate for Payer: Cash Price |
$4,688.98
|
| Rate for Payer: Cofinity Commercial |
$5,509.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,688.98
|
| Rate for Payer: Healthscope Commercial |
$5,685.39
|
| Rate for Payer: Healthscope Whirlpool |
$5,861.23
|
| Rate for Payer: Mclaren Commercial |
$5,275.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,982.05
|
| Rate for Payer: Nomi Health Commercial |
$4,806.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,395.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,157.88
|
|
|
HC SELECTIVE EXTRACRANIAL ARTERY UNI
|
Facility
|
IP
|
$9,738.02
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
36100377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,303.52 |
| Max. Negotiated Rate |
$9,738.02 |
| Rate for Payer: Aetna Commercial |
$8,764.22
|
| Rate for Payer: ASR ASR |
$9,445.88
|
| Rate for Payer: BCBS Trust/PPO |
$7,996.86
|
| Rate for Payer: BCN Commercial |
$7,996.86
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Commercial |
$9,153.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Healthscope Commercial |
$9,445.88
|
| Rate for Payer: Healthscope Whirlpool |
$9,738.02
|
| Rate for Payer: Mclaren Commercial |
$8,764.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Nomi Health Commercial |
$7,985.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,569.46
|
|
|
HC SELECTIVE EXTRACRANIAL ARTERY UNI
|
Facility
|
OP
|
$9,738.02
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
36100377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$9,738.02 |
| Rate for Payer: Aetna Commercial |
$8,764.22
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$9,445.88
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$8,029.00
|
| Rate for Payer: BCN Commercial |
$8,029.00
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Commercial |
$9,153.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$9,445.88
|
| Rate for Payer: Healthscope Whirlpool |
$9,738.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$8,764.22
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Nomi Health Commercial |
$7,985.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,801.97
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,241.57
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,569.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SELECTIVE EXTRA/INTRACRANIAL ARTERY UNI
|
Facility
|
OP
|
$11,185.55
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
36100378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,241.57 |
| Max. Negotiated Rate |
$11,185.55 |
| Rate for Payer: Aetna Commercial |
$10,067.00
|
| Rate for Payer: Aetna Medicare |
$5,544.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: ASR ASR |
$10,849.98
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$9,222.49
|
| Rate for Payer: BCN Commercial |
$9,222.49
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$8,948.44
|
| Rate for Payer: Cash Price |
$8,948.44
|
| Rate for Payer: Cofinity Commercial |
$10,514.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,948.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$10,849.98
|
| Rate for Payer: Healthscope Whirlpool |
$11,185.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,544.48
|
| Rate for Payer: Mclaren Commercial |
$10,067.00
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$3,045.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,507.72
|
| Rate for Payer: Nomi Health Commercial |
$9,172.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,389.16
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$6,098.93
|
| Rate for Payer: PHP Medicaid |
$2,971.84
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,801.97
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health Narrow Network |
$2,241.57
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,843.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Exchange |
$8,593.94
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP DNSP |
$5,544.48
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
HC SELECTIVE EXTRA/INTRACRANIAL ARTERY UNI
|
Facility
|
IP
|
$11,185.55
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
36100378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,389.16 |
| Max. Negotiated Rate |
$11,185.55 |
| Rate for Payer: Aetna Commercial |
$10,067.00
|
| Rate for Payer: ASR ASR |
$10,849.98
|
| Rate for Payer: BCBS Trust/PPO |
$9,185.57
|
| Rate for Payer: BCN Commercial |
$9,185.57
|
| Rate for Payer: Cash Price |
$8,948.44
|
| Rate for Payer: Cofinity Commercial |
$10,514.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,948.44
|
| Rate for Payer: Healthscope Commercial |
$10,849.98
|
| Rate for Payer: Healthscope Whirlpool |
$11,185.55
|
| Rate for Payer: Mclaren Commercial |
$10,067.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,507.72
|
| Rate for Payer: Nomi Health Commercial |
$9,172.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,389.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,843.28
|
|
|
HC SELECTIVE INTRACRANIAL ART UNI
|
Facility
|
IP
|
$13,546.53
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
36100385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,159.90 |
| Max. Negotiated Rate |
$13,546.53 |
| Rate for Payer: Aetna Commercial |
$12,191.88
|
| Rate for Payer: ASR ASR |
$13,140.13
|
| Rate for Payer: BCBS Trust/PPO |
$11,124.41
|
| Rate for Payer: BCN Commercial |
$11,124.41
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Commercial |
$12,733.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Healthscope Commercial |
$13,140.13
|
| Rate for Payer: Healthscope Whirlpool |
$13,546.53
|
| Rate for Payer: Mclaren Commercial |
$12,191.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,514.55
|
| Rate for Payer: Nomi Health Commercial |
$11,108.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,920.95
|
|
|
HC SELECTIVE INTRACRANIAL ART UNI
|
Facility
|
OP
|
$13,546.53
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
36100385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$13,546.53 |
| Rate for Payer: Aetna Commercial |
$12,191.88
|
| Rate for Payer: Aetna Medicare |
$5,544.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: ASR ASR |
$13,140.13
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$11,169.11
|
| Rate for Payer: BCN Commercial |
$11,169.11
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Commercial |
$12,733.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$13,140.13
|
| Rate for Payer: Healthscope Whirlpool |
$13,546.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,544.48
|
| Rate for Payer: Mclaren Commercial |
$12,191.88
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$3,045.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,514.55
|
| Rate for Payer: Nomi Health Commercial |
$11,108.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$6,098.93
|
| Rate for Payer: PHP Medicaid |
$2,971.84
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,582.48
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,665.99
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,920.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Exchange |
$8,593.94
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP DNSP |
$5,544.48
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
HC SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$13,546.53
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
36100381
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,159.90 |
| Max. Negotiated Rate |
$13,546.53 |
| Rate for Payer: Aetna Commercial |
$12,191.88
|
| Rate for Payer: ASR ASR |
$13,140.13
|
| Rate for Payer: BCBS Trust/PPO |
$11,124.41
|
| Rate for Payer: BCN Commercial |
$11,124.41
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Commercial |
$12,733.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Healthscope Commercial |
$13,140.13
|
| Rate for Payer: Healthscope Whirlpool |
$13,546.53
|
| Rate for Payer: Mclaren Commercial |
$12,191.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,514.55
|
| Rate for Payer: Nomi Health Commercial |
$11,108.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,920.95
|
|
|
HC SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$13,546.53
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
36100381
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$13,546.53 |
| Rate for Payer: Aetna Commercial |
$12,191.88
|
| Rate for Payer: Aetna Medicare |
$5,544.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: ASR ASR |
$13,140.13
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$11,169.11
|
| Rate for Payer: BCN Commercial |
$11,169.11
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Commercial |
$12,733.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$13,140.13
|
| Rate for Payer: Healthscope Whirlpool |
$13,546.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,544.48
|
| Rate for Payer: Mclaren Commercial |
$12,191.88
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$3,045.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,514.55
|
| Rate for Payer: Nomi Health Commercial |
$11,108.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$6,098.93
|
| Rate for Payer: PHP Medicaid |
$2,971.84
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,582.48
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,665.99
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,920.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Exchange |
$8,593.94
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP DNSP |
$5,544.48
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
IP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,264.74 |
| Max. Negotiated Rate |
$1,686.32 |
| Rate for Payer: Aetna Commercial |
$1,517.69
|
| Rate for Payer: ASR ASR |
$1,635.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.81
|
| Rate for Payer: BCN Commercial |
$1,384.81
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Commercial |
$1,585.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.06
|
| Rate for Payer: Healthscope Commercial |
$1,635.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,686.32
|
| Rate for Payer: Mclaren Commercial |
$1,517.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.37
|
| Rate for Payer: Nomi Health Commercial |
$1,382.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,264.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,483.96
|
|
|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
OP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$623.94 |
| Max. Negotiated Rate |
$1,686.32 |
| Rate for Payer: Aetna Commercial |
$1,517.69
|
| Rate for Payer: Aetna Medicare |
$623.94
|
| Rate for Payer: ASR ASR |
$1,635.73
|
| Rate for Payer: BCBS Complete |
$674.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,390.37
|
| Rate for Payer: BCN Commercial |
$1,390.37
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Commercial |
$1,585.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.06
|
| Rate for Payer: Healthscope Commercial |
$1,635.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,686.32
|
| Rate for Payer: Mclaren Commercial |
$1,517.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,349.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.37
|
| Rate for Payer: Nomi Health Commercial |
$1,382.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,264.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,477.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,182.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,483.96
|
|
|
HC SELENIUM LEVEL
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$25.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.91
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$14.02
|
| Rate for Payer: BCBS MAPPO |
$25.53
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$25.53
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.53
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.53
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$25.53
|
| Rate for Payer: Mclaren Medicare |
$25.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.81
|
| Rate for Payer: Meridian Medicaid |
$14.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$24.25
|
| Rate for Payer: PACE SWMI |
$25.53
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Medicaid |
$13.68
|
| Rate for Payer: PHP Medicare Advantage |
$25.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.49
|
| Rate for Payer: Priority Health Medicare |
$25.53
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$25.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.53
|
| Rate for Payer: UHC Exchange |
$39.57
|
| Rate for Payer: UHC Medicaid |
$13.35
|
| Rate for Payer: UHCCP DNSP |
$25.53
|
| Rate for Payer: UHCCP Medicaid |
$13.35
|
| Rate for Payer: VA VA |
$25.53
|
|
|
HC SELENIUM LEVEL
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
OP
|
$0.53
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna Commercial |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.20
|
| Rate for Payer: ASR ASR |
$0.51
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCN Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.51
|
| Rate for Payer: Healthscope Whirlpool |
$0.53
|
| Rate for Payer: Mclaren Commercial |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.45
|
| Rate for Payer: Nomi Health Commercial |
$0.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.46
|
| Rate for Payer: Priority Health Narrow Network |
$0.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.47
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
IP
|
$0.53
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna Commercial |
$0.48
|
| Rate for Payer: ASR ASR |
$0.51
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCN Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.51
|
| Rate for Payer: Healthscope Whirlpool |
$0.53
|
| Rate for Payer: Mclaren Commercial |
$0.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.45
|
| Rate for Payer: Nomi Health Commercial |
$0.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.47
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
OP
|
$57.53
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$57.53 |
| Rate for Payer: Aetna Commercial |
$51.78
|
| Rate for Payer: Aetna Medicare |
$21.29
|
| Rate for Payer: ASR ASR |
$55.80
|
| Rate for Payer: BCBS Complete |
$23.01
|
| Rate for Payer: BCBS Trust/PPO |
$47.43
|
| Rate for Payer: BCN Commercial |
$47.43
|
| Rate for Payer: Cash Price |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$54.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.02
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Healthscope Whirlpool |
$57.53
|
| Rate for Payer: Mclaren Commercial |
$51.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.90
|
| Rate for Payer: Nomi Health Commercial |
$47.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$50.41
|
| Rate for Payer: Priority Health Narrow Network |
$40.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.63
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
IP
|
$57.53
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$43.15 |
| Max. Negotiated Rate |
$57.53 |
| Rate for Payer: Aetna Commercial |
$51.78
|
| Rate for Payer: ASR ASR |
$55.80
|
| Rate for Payer: BCBS Trust/PPO |
$47.24
|
| Rate for Payer: BCN Commercial |
$47.24
|
| Rate for Payer: Cash Price |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$54.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.02
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Healthscope Whirlpool |
$57.53
|
| Rate for Payer: Mclaren Commercial |
$51.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.90
|
| Rate for Payer: Nomi Health Commercial |
$47.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.63
|
|
|
HC SEMEN EXAM FERTILITY
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| Rate for Payer: Aetna Medicare |
$12.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.39
|
| Rate for Payer: ASR ASR |
$114.04
|
| Rate for Payer: BCBS Complete |
$6.76
|
| Rate for Payer: BCBS MAPPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$96.94
|
| Rate for Payer: BCN Commercial |
$96.94
|
| Rate for Payer: BCN Medicare Advantage |
$12.31
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$114.04
|
| Rate for Payer: Healthscope Whirlpool |
$117.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.31
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Mclaren Medicaid |
$12.31
|
| Rate for Payer: Mclaren Medicare |
$12.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.93
|
| Rate for Payer: Meridian Medicaid |
$6.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Medicare |
$11.69
|
| Rate for Payer: PACE SWMI |
$12.31
|
| Rate for Payer: PHP Commercial |
$13.54
|
| Rate for Payer: PHP Medicaid |
$6.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$103.01
|
| Rate for Payer: Priority Health Medicare |
$12.31
|
| Rate for Payer: Priority Health Narrow Network |
$82.42
|
| Rate for Payer: Railroad Medicare Medicare |
$12.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.31
|
| Rate for Payer: UHC Exchange |
$19.08
|
| Rate for Payer: UHC Medicaid |
$6.44
|
| Rate for Payer: UHCCP DNSP |
$12.31
|
| Rate for Payer: UHCCP Medicaid |
$6.44
|
| Rate for Payer: VA VA |
$12.31
|
|
