|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
OP
|
$1,796.14
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$705.88 |
| Max. Negotiated Rate |
$1,616.53 |
| Rate for Payer: Aetna Commercial |
$1,526.72
|
| Rate for Payer: Aetna Medicare |
$898.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,167.49
|
| Rate for Payer: BCBS Complete |
$718.46
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cofinity Advantage |
$1,257.30
|
| Rate for Payer: Cofinity Commercial |
$1,544.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,436.91
|
| Rate for Payer: Healthscope Commercial |
$1,616.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,436.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,347.11
|
| Rate for Payer: PHP Commercial |
$1,526.72
|
| Rate for Payer: Priority Health SBD |
$1,131.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,167.49
|
| Rate for Payer: UHC Core |
$935.79
|
| Rate for Payer: UHC Exchange |
$705.88
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
OP
|
$2,099.99
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$825.30 |
| Max. Negotiated Rate |
$1,889.99 |
| Rate for Payer: Aetna Commercial |
$1,784.99
|
| Rate for Payer: Aetna Medicare |
$1,049.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,364.99
|
| Rate for Payer: BCBS Complete |
$840.00
|
| Rate for Payer: Cash Price |
$1,679.99
|
| Rate for Payer: Cofinity Advantage |
$1,469.99
|
| Rate for Payer: Cofinity Commercial |
$1,805.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,679.99
|
| Rate for Payer: Healthscope Commercial |
$1,889.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,679.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,784.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,574.99
|
| Rate for Payer: PHP Commercial |
$1,784.99
|
| Rate for Payer: Priority Health SBD |
$1,322.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,364.99
|
| Rate for Payer: UHC Core |
$1,094.09
|
| Rate for Payer: UHC Exchange |
$825.30
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
IP
|
$2,099.99
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,322.99 |
| Max. Negotiated Rate |
$1,889.99 |
| Rate for Payer: Aetna Commercial |
$1,784.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,364.99
|
| Rate for Payer: Cash Price |
$1,679.99
|
| Rate for Payer: Cofinity Advantage |
$1,469.99
|
| Rate for Payer: Cofinity Commercial |
$1,805.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,679.99
|
| Rate for Payer: Healthscope Commercial |
$1,889.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,784.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,574.99
|
| Rate for Payer: PHP Commercial |
$1,784.99
|
| Rate for Payer: Priority Health SBD |
$1,322.99
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
IP
|
$2,295.29
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,446.03 |
| Max. Negotiated Rate |
$2,065.76 |
| Rate for Payer: Aetna Commercial |
$1,951.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,491.94
|
| Rate for Payer: Cash Price |
$1,836.23
|
| Rate for Payer: Cofinity Advantage |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,973.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,836.23
|
| Rate for Payer: Healthscope Commercial |
$2,065.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,951.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,721.47
|
| Rate for Payer: PHP Commercial |
$1,951.00
|
| Rate for Payer: Priority Health SBD |
$1,446.03
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
OP
|
$2,295.29
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$902.05 |
| Max. Negotiated Rate |
$2,065.76 |
| Rate for Payer: Aetna Commercial |
$1,951.00
|
| Rate for Payer: Aetna Medicare |
$1,147.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,491.94
|
| Rate for Payer: BCBS Complete |
$918.12
|
| Rate for Payer: Cash Price |
$1,836.23
|
| Rate for Payer: Cofinity Advantage |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,973.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,836.23
|
| Rate for Payer: Healthscope Commercial |
$2,065.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,836.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,951.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,721.47
|
| Rate for Payer: PHP Commercial |
$1,951.00
|
| Rate for Payer: Priority Health SBD |
$1,446.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,491.94
|
| Rate for Payer: UHC Core |
$1,195.85
|
| Rate for Payer: UHC Exchange |
$902.05
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
OP
|
$1,964.32
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$771.98 |
| Max. Negotiated Rate |
$1,767.89 |
| Rate for Payer: Aetna Commercial |
$1,669.67
|
| Rate for Payer: Aetna Medicare |
$982.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.81
|
| Rate for Payer: BCBS Complete |
$785.73
|
| Rate for Payer: Cash Price |
$1,571.46
|
| Rate for Payer: Cofinity Advantage |
$1,375.02
|
| Rate for Payer: Cofinity Commercial |
$1,689.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.46
|
| Rate for Payer: Healthscope Commercial |
$1,767.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,571.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.24
|
| Rate for Payer: PHP Commercial |
$1,669.67
|
| Rate for Payer: Priority Health SBD |
$1,237.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,276.81
|
| Rate for Payer: UHC Core |
$1,023.41
|
| Rate for Payer: UHC Exchange |
$771.98
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
IP
|
$1,964.32
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,237.52 |
| Max. Negotiated Rate |
$1,767.89 |
| Rate for Payer: Aetna Commercial |
$1,669.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.81
|
| Rate for Payer: Cash Price |
$1,571.46
|
| Rate for Payer: Cofinity Advantage |
$1,375.02
|
| Rate for Payer: Cofinity Commercial |
$1,689.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.46
|
| Rate for Payer: Healthscope Commercial |
$1,767.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.24
|
| Rate for Payer: PHP Commercial |
$1,669.67
|
| Rate for Payer: Priority Health SBD |
$1,237.52
|
|
|
HC EXTENDED RECOVERY PER HR
|
Facility
|
IP
|
$145.86
|
|
| Hospital Charge Code |
71000038
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$91.89 |
| Max. Negotiated Rate |
$131.27 |
| Rate for Payer: Aetna Commercial |
$123.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.81
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Advantage |
$102.10
|
| Rate for Payer: Cofinity Commercial |
$125.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.69
|
| Rate for Payer: Healthscope Commercial |
$131.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.39
|
| Rate for Payer: PHP Commercial |
$123.98
|
| Rate for Payer: Priority Health SBD |
$91.89
|
|
|
HC EXTENDED RECOVERY PER HR
|
Facility
|
OP
|
$145.86
|
|
| Hospital Charge Code |
71000038
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$57.32 |
| Max. Negotiated Rate |
$131.27 |
| Rate for Payer: Aetna Commercial |
$123.98
|
| Rate for Payer: Aetna Medicare |
$72.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.81
|
| Rate for Payer: BCBS Complete |
$58.34
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Advantage |
$102.10
|
| Rate for Payer: Cofinity Commercial |
$125.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.69
|
| Rate for Payer: Healthscope Commercial |
$131.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.39
|
| Rate for Payer: PHP Commercial |
$123.98
|
| Rate for Payer: Priority Health SBD |
$91.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.81
|
| Rate for Payer: UHC Core |
$75.99
|
| Rate for Payer: UHC Exchange |
$57.32
|
|
|
HC EXTENSION KIT
|
Facility
|
IP
|
$2,072.62
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,305.75 |
| Max. Negotiated Rate |
$1,865.36 |
| Rate for Payer: Aetna Commercial |
$1,761.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.20
|
| Rate for Payer: Cash Price |
$1,658.10
|
| Rate for Payer: Cofinity Advantage |
$1,450.83
|
| Rate for Payer: Cofinity Commercial |
$1,782.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.10
|
| Rate for Payer: Healthscope Commercial |
$1,865.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,554.46
|
| Rate for Payer: PHP Commercial |
$1,761.73
|
| Rate for Payer: Priority Health SBD |
$1,305.75
|
|
|
HC EXTENSION KIT
|
Facility
|
OP
|
$2,072.62
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$814.54 |
| Max. Negotiated Rate |
$1,865.36 |
| Rate for Payer: Aetna Commercial |
$1,761.73
|
| Rate for Payer: Aetna Medicare |
$1,036.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.20
|
| Rate for Payer: BCBS Complete |
$829.05
|
| Rate for Payer: Cash Price |
$1,658.10
|
| Rate for Payer: Cofinity Advantage |
$1,450.83
|
| Rate for Payer: Cofinity Commercial |
$1,782.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.10
|
| Rate for Payer: Healthscope Commercial |
$1,865.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,658.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,554.46
|
| Rate for Payer: PHP Commercial |
$1,761.73
|
| Rate for Payer: Priority Health SBD |
$1,305.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,347.20
|
| Rate for Payer: UHC Core |
$1,079.84
|
| Rate for Payer: UHC Exchange |
$814.54
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
IP
|
$2,418.07
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.38 |
| Max. Negotiated Rate |
$2,176.26 |
| Rate for Payer: Aetna Commercial |
$2,055.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,571.75
|
| Rate for Payer: Cash Price |
$1,934.46
|
| Rate for Payer: Cofinity Advantage |
$1,692.65
|
| Rate for Payer: Cofinity Commercial |
$2,079.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.46
|
| Rate for Payer: Healthscope Commercial |
$2,176.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,055.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,813.55
|
| Rate for Payer: PHP Commercial |
$2,055.36
|
| Rate for Payer: Priority Health SBD |
$1,523.38
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
OP
|
$2,418.07
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.30 |
| Max. Negotiated Rate |
$2,176.26 |
| Rate for Payer: Aetna Commercial |
$2,055.36
|
| Rate for Payer: Aetna Medicare |
$1,209.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,571.75
|
| Rate for Payer: BCBS Complete |
$967.23
|
| Rate for Payer: Cash Price |
$1,934.46
|
| Rate for Payer: Cofinity Advantage |
$1,692.65
|
| Rate for Payer: Cofinity Commercial |
$2,079.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.46
|
| Rate for Payer: Healthscope Commercial |
$2,176.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,055.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,813.55
|
| Rate for Payer: PHP Commercial |
$2,055.36
|
| Rate for Payer: Priority Health SBD |
$1,523.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,571.75
|
| Rate for Payer: UHC Core |
$1,259.81
|
| Rate for Payer: UHC Exchange |
$950.30
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
OP
|
$92.95
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna Commercial |
$79.01
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$39.69
|
| Rate for Payer: BCN Commercial |
$39.69
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Cofinity Advantage |
$65.06
|
| Rate for Payer: Cofinity Commercial |
$79.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$83.66
|
| Rate for Payer: Mclaren Medicaid |
$19.47
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$39.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.01
|
| Rate for Payer: Nomi Health Commercial |
$111.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.71
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$79.01
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.34
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health SBD |
$58.56
|
| Rate for Payer: Priority Health Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.42
|
| Rate for Payer: UHC Core |
$48.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$36.53
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
IP
|
$92.95
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$58.56 |
| Max. Negotiated Rate |
$83.66 |
| Rate for Payer: Aetna Commercial |
$79.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.42
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Cofinity Advantage |
$65.06
|
| Rate for Payer: Cofinity Commercial |
$79.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.36
|
| Rate for Payer: Healthscope Commercial |
$83.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.71
|
| Rate for Payer: PHP Commercial |
$79.01
|
| Rate for Payer: Priority Health SBD |
$58.56
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
OP
|
$140.14
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$126.13 |
| Rate for Payer: Aetna Commercial |
$119.12
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$39.69
|
| Rate for Payer: BCN Commercial |
$39.69
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$112.11
|
| Rate for Payer: Cash Price |
$112.11
|
| Rate for Payer: Cofinity Advantage |
$98.10
|
| Rate for Payer: Cofinity Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$126.13
|
| Rate for Payer: Mclaren Medicaid |
$19.47
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$39.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.12
|
| Rate for Payer: Nomi Health Commercial |
$111.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.11
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$119.12
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.34
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health SBD |
$88.29
|
| Rate for Payer: Priority Health Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.09
|
| Rate for Payer: UHC Core |
$73.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$55.08
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
IP
|
$140.14
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$88.29 |
| Max. Negotiated Rate |
$126.13 |
| Rate for Payer: Aetna Commercial |
$119.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.09
|
| Rate for Payer: Cash Price |
$112.11
|
| Rate for Payer: Cofinity Advantage |
$98.10
|
| Rate for Payer: Cofinity Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.11
|
| Rate for Payer: Healthscope Commercial |
$126.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.11
|
| Rate for Payer: PHP Commercial |
$119.12
|
| Rate for Payer: Priority Health SBD |
$88.29
|
|
|
HC EXTERNAL PACER
|
Facility
|
IP
|
$587.96
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$370.41 |
| Max. Negotiated Rate |
$529.16 |
| Rate for Payer: Aetna Commercial |
$499.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.17
|
| Rate for Payer: Cash Price |
$470.37
|
| Rate for Payer: Cofinity Advantage |
$411.57
|
| Rate for Payer: Cofinity Commercial |
$505.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.37
|
| Rate for Payer: Healthscope Commercial |
$529.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.97
|
| Rate for Payer: PHP Commercial |
$499.77
|
| Rate for Payer: Priority Health SBD |
$370.41
|
|
|
HC EXTERNAL PACER
|
Facility
|
OP
|
$587.96
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2,129.73 |
| Rate for Payer: Aetna Commercial |
$499.77
|
| Rate for Payer: Aetna Medicare |
$684.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.21
|
| Rate for Payer: BCBS Complete |
$361.69
|
| Rate for Payer: BCBS MAPPO |
$658.57
|
| Rate for Payer: BCBS Trust/PPO |
$1.47
|
| Rate for Payer: BCN Commercial |
$1.47
|
| Rate for Payer: BCN Medicare Advantage |
$658.57
|
| Rate for Payer: Cash Price |
$470.37
|
| Rate for Payer: Cash Price |
$470.37
|
| Rate for Payer: Cofinity Advantage |
$411.57
|
| Rate for Payer: Cofinity Commercial |
$505.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.57
|
| Rate for Payer: Healthscope Commercial |
$529.16
|
| Rate for Payer: Mclaren Medicaid |
$344.43
|
| Rate for Payer: Mclaren Medicare |
$658.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.50
|
| Rate for Payer: Meridian Medicaid |
$691.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$724.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.77
|
| Rate for Payer: Nomi Health Commercial |
$1,975.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.97
|
| Rate for Payer: PACE Medicare |
$625.64
|
| Rate for Payer: PACE SWMI |
$658.57
|
| Rate for Payer: PHP Commercial |
$499.77
|
| Rate for Payer: PHP Medicare Advantage |
$658.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,129.73
|
| Rate for Payer: Priority Health Medicare |
$658.57
|
| Rate for Payer: Priority Health SBD |
$370.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,703.78
|
| Rate for Payer: Railroad Medicare Medicare |
$658.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.17
|
| Rate for Payer: UHC Core |
$306.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$658.57
|
| Rate for Payer: UHC Exchange |
$231.07
|
| Rate for Payer: UHC Medicaid |
$344.43
|
| Rate for Payer: UHCCP Medicaid |
$344.43
|
| Rate for Payer: VA VA |
$658.57
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$2,895.09
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$594.72 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Commercial |
$2,460.83
|
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,881.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$594.72
|
| Rate for Payer: BCN Commercial |
$594.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$2,316.07
|
| Rate for Payer: Cash Price |
$2,316.07
|
| Rate for Payer: Cash Price |
$2,316.07
|
| Rate for Payer: Cofinity Advantage |
$2,026.56
|
| Rate for Payer: Cofinity Commercial |
$2,489.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,316.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$2,605.58
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,460.83
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,171.32
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$2,460.83
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health SBD |
$1,823.91
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,881.81
|
| Rate for Payer: UHC Core |
$1,508.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$1,137.77
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$2,895.09
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,823.91 |
| Max. Negotiated Rate |
$2,605.58 |
| Rate for Payer: Aetna Commercial |
$2,460.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,881.81
|
| Rate for Payer: Cash Price |
$2,316.07
|
| Rate for Payer: Cofinity Advantage |
$2,026.56
|
| Rate for Payer: Cofinity Commercial |
$2,489.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,316.07
|
| Rate for Payer: Healthscope Commercial |
$2,605.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,460.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,171.32
|
| Rate for Payer: PHP Commercial |
$2,460.83
|
| Rate for Payer: Priority Health SBD |
$1,823.91
|
|
|
HC EXTRACTION
|
Facility
|
IP
|
$278.14
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
76100282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.23 |
| Max. Negotiated Rate |
$250.33 |
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.79
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Advantage |
$194.70
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: Priority Health SBD |
$175.23
|
|
|
HC EXTRACTION
|
Facility
|
OP
|
$278.14
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
76100282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$62.40
|
| Rate for Payer: BCN Commercial |
$62.40
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Advantage |
$194.70
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$175.23
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.79
|
| Rate for Payer: UHC Core |
$144.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$109.31
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
OP
|
$398.50
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.61 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$338.73
|
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$273.85
|
| Rate for Payer: BCN Commercial |
$273.85
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Cash Price |
$318.80
|
| Rate for Payer: Cash Price |
$318.80
|
| Rate for Payer: Cash Price |
$318.80
|
| Rate for Payer: Cofinity Advantage |
$278.95
|
| Rate for Payer: Cofinity Commercial |
$342.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Healthscope Commercial |
$358.65
|
| Rate for Payer: Mclaren Medicaid |
$281.05
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.73
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.88
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Commercial |
$338.73
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health SBD |
$251.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.02
|
| Rate for Payer: UHC Core |
$207.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Exchange |
$156.61
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
IP
|
$398.50
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.06 |
| Max. Negotiated Rate |
$358.65 |
| Rate for Payer: Aetna Commercial |
$338.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.02
|
| Rate for Payer: Cash Price |
$318.80
|
| Rate for Payer: Cofinity Advantage |
$278.95
|
| Rate for Payer: Cofinity Commercial |
$342.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.80
|
| Rate for Payer: Healthscope Commercial |
$358.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.88
|
| Rate for Payer: PHP Commercial |
$338.73
|
| Rate for Payer: Priority Health SBD |
$251.06
|
|
