|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna Medicare |
$247.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: BCBS Trust/PPO |
$88.95
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$88.95
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Advantage |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health SBD |
$311.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.38
|
| Rate for Payer: UHC Core |
$257.60
|
| Rate for Payer: UHC Exchange |
$194.31
|
|
|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$311.49 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Advantage |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health SBD |
$311.49
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$433.98 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Advantage |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.64
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health SBD |
$433.98
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.68 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna Medicare |
$344.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS Trust/PPO |
$119.83
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$119.83
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Advantage |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$551.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.64
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health SBD |
$433.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.75
|
| Rate for Payer: UHC Core |
$358.89
|
| Rate for Payer: UHC Exchange |
$270.72
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$550.95 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.44
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Advantage |
$612.16
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.89
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health SBD |
$550.95
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.68 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna Medicare |
$437.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.44
|
| Rate for Payer: BCBS Complete |
$349.81
|
| Rate for Payer: BCBS Trust/PPO |
$163.92
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$163.92
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Advantage |
$612.16
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.89
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health SBD |
$550.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$568.44
|
| Rate for Payer: UHC Core |
$455.62
|
| Rate for Payer: UHC Exchange |
$343.69
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
OP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$211.09 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: Aetna Medicare |
$521.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.87
|
| Rate for Payer: BCBS Complete |
$417.15
|
| Rate for Payer: BCBS Trust/PPO |
$211.09
|
| Rate for Payer: BCN Commercial |
$211.09
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Advantage |
$730.02
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$834.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.16
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: Priority Health SBD |
$657.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$677.87
|
| Rate for Payer: UHC Core |
$543.34
|
| Rate for Payer: UHC Exchange |
$409.85
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
IP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$657.01 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.87
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Advantage |
$730.02
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.16
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: Priority Health SBD |
$657.01
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
OP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$335.47 |
| Rate for Payer: Aetna Commercial |
$316.83
|
| Rate for Payer: Aetna Medicare |
$186.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.28
|
| Rate for Payer: BCBS Complete |
$149.10
|
| Rate for Payer: BCBS Trust/PPO |
$49.51
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$49.51
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Advantage |
$260.92
|
| Rate for Payer: Cofinity Commercial |
$320.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Healthscope Commercial |
$335.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.56
|
| Rate for Payer: PHP Commercial |
$316.83
|
| Rate for Payer: Priority Health SBD |
$234.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.28
|
| Rate for Payer: UHC Core |
$194.20
|
| Rate for Payer: UHC Exchange |
$146.49
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
IP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.83 |
| Max. Negotiated Rate |
$335.47 |
| Rate for Payer: Aetna Commercial |
$316.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.28
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Advantage |
$260.92
|
| Rate for Payer: Cofinity Commercial |
$320.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Healthscope Commercial |
$335.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.56
|
| Rate for Payer: PHP Commercial |
$316.83
|
| Rate for Payer: Priority Health SBD |
$234.83
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
OP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$148.64 |
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna Medicare |
$82.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.35
|
| Rate for Payer: BCBS Complete |
$66.06
|
| Rate for Payer: BCBS Trust/PPO |
$49.51
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$49.51
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Advantage |
$115.61
|
| Rate for Payer: Cofinity Commercial |
$142.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$148.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.87
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: Priority Health SBD |
$104.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.35
|
| Rate for Payer: UHC Core |
$86.05
|
| Rate for Payer: UHC Exchange |
$64.91
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
IP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.05 |
| Max. Negotiated Rate |
$148.64 |
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.35
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Advantage |
$115.61
|
| Rate for Payer: Cofinity Commercial |
$142.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$148.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.87
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: Priority Health SBD |
$104.05
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.62 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna Medicare |
$247.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: BCBS Trust/PPO |
$120.58
|
| Rate for Payer: BCCCP Commercial |
$68.62
|
| Rate for Payer: BCN Commercial |
$120.58
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Advantage |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health SBD |
$311.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.38
|
| Rate for Payer: UHC Core |
$257.60
|
| Rate for Payer: UHC Exchange |
$194.31
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$311.49 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Advantage |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health SBD |
$311.49
|
|
|
HC ACB NEW PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$433.98 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Advantage |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.64
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health SBD |
$433.98
|
|
|
HC ACB NEW PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna Medicare |
$344.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS Trust/PPO |
$159.36
|
| Rate for Payer: BCCCP Commercial |
$108.06
|
| Rate for Payer: BCN Commercial |
$159.36
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Advantage |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$551.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.64
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health SBD |
$433.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.75
|
| Rate for Payer: UHC Core |
$358.89
|
| Rate for Payer: UHC Exchange |
$270.72
|
|
|
HC ACB NEW PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$550.95 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.44
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Advantage |
$612.16
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.89
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health SBD |
$550.95
|
|
|
HC ACB NEW PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna Medicare |
$437.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.44
|
| Rate for Payer: BCBS Complete |
$349.81
|
| Rate for Payer: BCBS Trust/PPO |
$213.18
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$213.18
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Advantage |
$612.16
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.89
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health SBD |
$550.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$568.44
|
| Rate for Payer: UHC Core |
$455.62
|
| Rate for Payer: UHC Exchange |
$343.69
|
|
|
HC ACB NEW PT LEVEL 5
|
Facility
|
OP
|
$1,042.88
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: Aetna Medicare |
$521.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.87
|
| Rate for Payer: BCBS Complete |
$417.15
|
| Rate for Payer: BCBS Trust/PPO |
$258.37
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$258.37
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Advantage |
$730.02
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$834.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.16
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: Priority Health SBD |
$657.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$677.87
|
| Rate for Payer: UHC Core |
$543.34
|
| Rate for Payer: UHC Exchange |
$409.85
|
|
|
HC ACB NEW PT LEVEL 5
|
Facility
|
IP
|
$1,042.88
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$657.01 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.87
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Advantage |
$730.02
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.16
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: Priority Health SBD |
$657.01
|
|
|
HC ACCESS AORTA
|
Facility
|
OP
|
$3,998.72
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
36100105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,413.63 |
| Max. Negotiated Rate |
$3,598.85 |
| Rate for Payer: Aetna Commercial |
$3,398.91
|
| Rate for Payer: Aetna Medicare |
$1,999.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,599.17
|
| Rate for Payer: BCBS Complete |
$1,599.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,413.63
|
| Rate for Payer: BCN Commercial |
$1,413.63
|
| Rate for Payer: Cash Price |
$3,198.98
|
| Rate for Payer: Cash Price |
$3,198.98
|
| Rate for Payer: Cofinity Advantage |
$2,799.10
|
| Rate for Payer: Cofinity Commercial |
$3,438.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.98
|
| Rate for Payer: Healthscope Commercial |
$3,598.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,198.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,398.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.04
|
| Rate for Payer: PHP Commercial |
$3,398.91
|
| Rate for Payer: Priority Health SBD |
$2,519.19
|
|
|
HC ACCESS AORTA
|
Facility
|
IP
|
$3,998.72
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
36100105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,519.19 |
| Max. Negotiated Rate |
$3,598.85 |
| Rate for Payer: Aetna Commercial |
$3,398.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,599.17
|
| Rate for Payer: Cash Price |
$3,198.98
|
| Rate for Payer: Cofinity Advantage |
$2,799.10
|
| Rate for Payer: Cofinity Commercial |
$3,438.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.98
|
| Rate for Payer: Healthscope Commercial |
$3,598.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,398.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.04
|
| Rate for Payer: PHP Commercial |
$3,398.91
|
| Rate for Payer: Priority Health SBD |
$2,519.19
|
|
|
HC ACCESS EXTREMITY ARTERY
|
Facility
|
OP
|
$510.94
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
36100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$1,113.63 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: Aetna Medicare |
$255.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.11
|
| Rate for Payer: BCBS Complete |
$204.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.63
|
| Rate for Payer: BCN Commercial |
$1,113.63
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cofinity Advantage |
$357.66
|
| Rate for Payer: Cofinity Commercial |
$439.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.75
|
| Rate for Payer: Healthscope Commercial |
$459.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.20
|
| Rate for Payer: PHP Commercial |
$434.30
|
| Rate for Payer: Priority Health SBD |
$321.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.11
|
| Rate for Payer: UHC Core |
$266.20
|
| Rate for Payer: UHC Exchange |
$200.80
|
|
|
HC ACCESS EXTREMITY ARTERY
|
Facility
|
IP
|
$510.94
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
36100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.89 |
| Max. Negotiated Rate |
$459.85 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.11
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cofinity Advantage |
$357.66
|
| Rate for Payer: Cofinity Commercial |
$439.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.75
|
| Rate for Payer: Healthscope Commercial |
$459.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.20
|
| Rate for Payer: PHP Commercial |
$434.30
|
| Rate for Payer: Priority Health SBD |
$321.89
|
|
|
HC ACCESS MAIN PULMONARY
|
Facility
|
IP
|
$436.13
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
36100099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.76 |
| Max. Negotiated Rate |
$392.52 |
| Rate for Payer: Aetna Commercial |
$370.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.48
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cofinity Advantage |
$305.29
|
| Rate for Payer: Cofinity Commercial |
$375.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.90
|
| Rate for Payer: Healthscope Commercial |
$392.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.10
|
| Rate for Payer: PHP Commercial |
$370.71
|
| Rate for Payer: Priority Health SBD |
$274.76
|
|
