|
HC EXC TUMOR SOFT TISSUE THIGH/KNEE, SQ 3CM OR >
|
Facility
|
OP
|
$3,618.87
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
76100249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.01 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Commercial |
$3,076.04
|
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,352.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,400.64
|
| Rate for Payer: BCN Commercial |
$1,400.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$2,895.10
|
| Rate for Payer: Cash Price |
$2,895.10
|
| Rate for Payer: Cash Price |
$2,895.10
|
| Rate for Payer: Cofinity Commercial |
$3,112.23
|
| Rate for Payer: Cofinity Commercial |
$2,533.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,533.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,895.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$3,256.98
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,076.04
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,076.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,352.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Priority Health SBD |
$2,279.89
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.01
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,578.75
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
HC EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>
|
Facility
|
IP
|
$4,031.01
|
|
|
Service Code
|
CPT 24071
|
| Hospital Charge Code |
76100324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,539.54 |
| Max. Negotiated Rate |
$3,627.91 |
| Rate for Payer: Aetna Commercial |
$3,426.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,620.16
|
| Rate for Payer: Cash Price |
$3,224.81
|
| Rate for Payer: Cofinity Commercial |
$2,821.71
|
| Rate for Payer: Cofinity Commercial |
$3,466.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,821.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,224.81
|
| Rate for Payer: Healthscope Commercial |
$3,627.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,426.36
|
| Rate for Payer: PHP Commercial |
$3,426.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,620.16
|
| Rate for Payer: Priority Health SBD |
$2,539.54
|
|
|
HC EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>
|
Facility
|
OP
|
$4,031.01
|
|
|
Service Code
|
CPT 24071
|
| Hospital Charge Code |
76100324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$434.70 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Commercial |
$3,426.36
|
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,620.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,370.81
|
| Rate for Payer: BCN Commercial |
$1,370.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$3,224.81
|
| Rate for Payer: Cash Price |
$3,224.81
|
| Rate for Payer: Cash Price |
$3,224.81
|
| Rate for Payer: Cofinity Commercial |
$3,466.67
|
| Rate for Payer: Cofinity Commercial |
$2,821.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,821.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,224.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$3,627.91
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,426.36
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,426.36
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,620.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Priority Health SBD |
$2,539.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.70
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,578.75
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
OP
|
$7,960.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
76100527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.39 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Commercial |
$6,766.00
|
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,174.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$922.00
|
| Rate for Payer: BCN Commercial |
$922.00
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$6,368.00
|
| Rate for Payer: Cash Price |
$6,368.00
|
| Rate for Payer: Cash Price |
$6,368.00
|
| Rate for Payer: Cofinity Commercial |
$6,845.60
|
| Rate for Payer: Cofinity Commercial |
$5,572.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,572.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,368.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$7,164.00
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,766.00
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$6,766.00
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,174.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Priority Health SBD |
$5,014.80
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.39
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,578.75
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
HC EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
IP
|
$7,960.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
76100527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,014.80 |
| Max. Negotiated Rate |
$7,164.00 |
| Rate for Payer: Aetna Commercial |
$6,766.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,174.00
|
| Rate for Payer: Cash Price |
$6,368.00
|
| Rate for Payer: Cofinity Commercial |
$5,572.00
|
| Rate for Payer: Cofinity Commercial |
$6,845.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,572.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,368.00
|
| Rate for Payer: Healthscope Commercial |
$7,164.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,766.00
|
| Rate for Payer: PHP Commercial |
$6,766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,174.00
|
| Rate for Payer: Priority Health SBD |
$5,014.80
|
|
|
HC EXC TUMOR UPPER ARM/ELBOW SUBQ <3CM
|
Facility
|
OP
|
$2,927.69
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
76100310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.86 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$2,488.54
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,903.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$768.35
|
| Rate for Payer: BCN Commercial |
$768.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$2,342.15
|
| Rate for Payer: Cash Price |
$2,342.15
|
| Rate for Payer: Cash Price |
$2,342.15
|
| Rate for Payer: Cofinity Commercial |
$2,517.81
|
| Rate for Payer: Cofinity Commercial |
$2,049.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,049.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,342.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$2,634.92
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,488.54
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$2,488.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,903.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$1,844.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.86
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
HC EXC TUMOR UPPER ARM/ELBOW SUBQ <3CM
|
Facility
|
IP
|
$2,927.69
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
76100310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,844.44 |
| Max. Negotiated Rate |
$2,634.92 |
| Rate for Payer: Aetna Commercial |
$2,488.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,903.00
|
| Rate for Payer: Cash Price |
$2,342.15
|
| Rate for Payer: Cofinity Commercial |
$2,049.38
|
| Rate for Payer: Cofinity Commercial |
$2,517.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,049.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,342.15
|
| Rate for Payer: Healthscope Commercial |
$2,634.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,488.54
|
| Rate for Payer: PHP Commercial |
$2,488.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,903.00
|
| Rate for Payer: Priority Health SBD |
$1,844.44
|
|
|
HC EXERCISE CHALLENGE
|
Facility
|
IP
|
$1,020.24
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
48100108
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$642.75 |
| Max. Negotiated Rate |
$918.22 |
| Rate for Payer: Aetna Commercial |
$867.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.16
|
| Rate for Payer: Cash Price |
$816.19
|
| Rate for Payer: Cofinity Commercial |
$714.17
|
| Rate for Payer: Cofinity Commercial |
$877.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.19
|
| Rate for Payer: Healthscope Commercial |
$918.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.20
|
| Rate for Payer: PHP Commercial |
$867.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.16
|
| Rate for Payer: Priority Health SBD |
$642.75
|
|
|
HC EXERCISE CHALLENGE
|
Facility
|
OP
|
$1,020.24
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
48100108
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$221.17 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$867.20
|
| Rate for Payer: Aetna Medicare |
$510.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.16
|
| Rate for Payer: BCBS Complete |
$408.10
|
| Rate for Payer: BCBS Trust/PPO |
$581.78
|
| Rate for Payer: BCN Commercial |
$581.78
|
| Rate for Payer: Cash Price |
$816.19
|
| Rate for Payer: Cash Price |
$816.19
|
| Rate for Payer: Cash Price |
$816.19
|
| Rate for Payer: Cofinity Commercial |
$714.17
|
| Rate for Payer: Cofinity Commercial |
$877.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.19
|
| Rate for Payer: Healthscope Commercial |
$918.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.20
|
| Rate for Payer: PHP Commercial |
$867.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.16
|
| Rate for Payer: Priority Health SBD |
$642.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.17
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM W/EKG
|
Facility
|
OP
|
$344.70
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
46000033
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$396.95 |
| Rate for Payer: Aetna Commercial |
$293.00
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$256.93
|
| Rate for Payer: BCN Commercial |
$256.93
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$275.76
|
| Rate for Payer: Cash Price |
$275.76
|
| Rate for Payer: Cofinity Commercial |
$296.44
|
| Rate for Payer: Cofinity Commercial |
$241.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$310.23
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.00
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$293.00
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$217.16
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$255.08
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM W/EKG
|
Facility
|
IP
|
$344.70
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
46000033
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$217.16 |
| Max. Negotiated Rate |
$310.23 |
| Rate for Payer: Aetna Commercial |
$293.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.06
|
| Rate for Payer: Cash Price |
$275.76
|
| Rate for Payer: Cofinity Commercial |
$241.29
|
| Rate for Payer: Cofinity Commercial |
$296.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.76
|
| Rate for Payer: Healthscope Commercial |
$310.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.00
|
| Rate for Payer: PHP Commercial |
$293.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.06
|
| Rate for Payer: Priority Health SBD |
$217.16
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM WO ECG
|
Facility
|
IP
|
$136.25
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
46000032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$122.62 |
| Rate for Payer: Aetna Commercial |
$115.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.56
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cofinity Commercial |
$117.18
|
| Rate for Payer: Cofinity Commercial |
$95.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.00
|
| Rate for Payer: Healthscope Commercial |
$122.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.81
|
| Rate for Payer: PHP Commercial |
$115.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.56
|
| Rate for Payer: Priority Health SBD |
$85.84
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM WO ECG
|
Facility
|
OP
|
$136.25
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
46000032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$194.91 |
| Rate for Payer: Aetna Commercial |
$115.81
|
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$194.91
|
| Rate for Payer: BCN Commercial |
$194.91
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cofinity Commercial |
$95.38
|
| Rate for Payer: Cofinity Commercial |
$117.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$122.62
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.81
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$115.81
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Priority Health SBD |
$85.84
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$100.82
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$32.77
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$1,942.34
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,223.67 |
| Max. Negotiated Rate |
$1,748.11 |
| Rate for Payer: Aetna Commercial |
$1,650.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,262.52
|
| Rate for Payer: Cash Price |
$1,553.87
|
| Rate for Payer: Cofinity Commercial |
$1,359.64
|
| Rate for Payer: Cofinity Commercial |
$1,670.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,359.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.87
|
| Rate for Payer: Healthscope Commercial |
$1,748.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.99
|
| Rate for Payer: PHP Commercial |
$1,650.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.52
|
| Rate for Payer: Priority Health SBD |
$1,223.67
|
|
|
HC EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$1,942.34
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.43 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$1,650.99
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,262.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$458.82
|
| Rate for Payer: BCN Commercial |
$458.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$1,553.87
|
| Rate for Payer: Cash Price |
$1,553.87
|
| Rate for Payer: Cash Price |
$1,553.87
|
| Rate for Payer: Cofinity Commercial |
$1,670.41
|
| Rate for Payer: Cofinity Commercial |
$1,359.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,359.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$1,748.11
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.99
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,650.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$1,223.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.43
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
OP
|
$1,760.92
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$704.37 |
| Max. Negotiated Rate |
$1,584.83 |
| Rate for Payer: Aetna Commercial |
$1,496.78
|
| Rate for Payer: Aetna Medicare |
$880.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.60
|
| Rate for Payer: BCBS Complete |
$704.37
|
| Rate for Payer: Cash Price |
$1,408.74
|
| Rate for Payer: Cofinity Commercial |
$1,232.64
|
| Rate for Payer: Cofinity Commercial |
$1,514.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,232.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.74
|
| Rate for Payer: Healthscope Commercial |
$1,584.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.78
|
| Rate for Payer: PHP Commercial |
$1,496.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,144.60
|
| Rate for Payer: Priority Health SBD |
$1,109.38
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
IP
|
$1,760.92
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,109.38 |
| Max. Negotiated Rate |
$1,584.83 |
| Rate for Payer: Aetna Commercial |
$1,496.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.60
|
| Rate for Payer: Cash Price |
$1,408.74
|
| Rate for Payer: Cofinity Commercial |
$1,232.64
|
| Rate for Payer: Cofinity Commercial |
$1,514.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,232.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.74
|
| Rate for Payer: Healthscope Commercial |
$1,584.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.78
|
| Rate for Payer: PHP Commercial |
$1,496.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,144.60
|
| Rate for Payer: Priority Health SBD |
$1,109.38
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
OP
|
$2,058.81
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$823.52 |
| Max. Negotiated Rate |
$1,852.93 |
| Rate for Payer: Aetna Commercial |
$1,749.99
|
| Rate for Payer: Aetna Medicare |
$1,029.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,338.23
|
| Rate for Payer: BCBS Complete |
$823.52
|
| Rate for Payer: Cash Price |
$1,647.05
|
| Rate for Payer: Cofinity Commercial |
$1,441.17
|
| Rate for Payer: Cofinity Commercial |
$1,770.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,441.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,647.05
|
| Rate for Payer: Healthscope Commercial |
$1,852.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.99
|
| Rate for Payer: PHP Commercial |
$1,749.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,338.23
|
| Rate for Payer: Priority Health SBD |
$1,297.05
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
IP
|
$2,058.81
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,297.05 |
| Max. Negotiated Rate |
$1,852.93 |
| Rate for Payer: Aetna Commercial |
$1,749.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,338.23
|
| Rate for Payer: Cash Price |
$1,647.05
|
| Rate for Payer: Cofinity Commercial |
$1,441.17
|
| Rate for Payer: Cofinity Commercial |
$1,770.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,441.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,647.05
|
| Rate for Payer: Healthscope Commercial |
$1,852.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.99
|
| Rate for Payer: PHP Commercial |
$1,749.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,338.23
|
| Rate for Payer: Priority Health SBD |
$1,297.05
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
IP
|
$2,250.28
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,417.68 |
| Max. Negotiated Rate |
$2,025.25 |
| Rate for Payer: Aetna Commercial |
$1,912.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,462.68
|
| Rate for Payer: Cash Price |
$1,800.22
|
| Rate for Payer: Cofinity Commercial |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,935.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,575.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.22
|
| Rate for Payer: Healthscope Commercial |
$2,025.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.74
|
| Rate for Payer: PHP Commercial |
$1,912.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,462.68
|
| Rate for Payer: Priority Health SBD |
$1,417.68
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
OP
|
$2,250.28
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$900.11 |
| Max. Negotiated Rate |
$2,025.25 |
| Rate for Payer: Aetna Commercial |
$1,912.74
|
| Rate for Payer: Aetna Medicare |
$1,125.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,462.68
|
| Rate for Payer: BCBS Complete |
$900.11
|
| Rate for Payer: Cash Price |
$1,800.22
|
| Rate for Payer: Cofinity Commercial |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,935.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,575.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.22
|
| Rate for Payer: Healthscope Commercial |
$2,025.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.74
|
| Rate for Payer: PHP Commercial |
$1,912.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,462.68
|
| Rate for Payer: Priority Health SBD |
$1,417.68
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
IP
|
$1,925.80
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,213.25 |
| Max. Negotiated Rate |
$1,733.22 |
| Rate for Payer: Aetna Commercial |
$1,636.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.77
|
| Rate for Payer: Cash Price |
$1,540.64
|
| Rate for Payer: Cofinity Commercial |
$1,348.06
|
| Rate for Payer: Cofinity Commercial |
$1,656.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,348.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.64
|
| Rate for Payer: Healthscope Commercial |
$1,733.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.93
|
| Rate for Payer: PHP Commercial |
$1,636.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.77
|
| Rate for Payer: Priority Health SBD |
$1,213.25
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
OP
|
$1,925.80
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$770.32 |
| Max. Negotiated Rate |
$1,733.22 |
| Rate for Payer: Aetna Commercial |
$1,636.93
|
| Rate for Payer: Aetna Medicare |
$962.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.77
|
| Rate for Payer: BCBS Complete |
$770.32
|
| Rate for Payer: Cash Price |
$1,540.64
|
| Rate for Payer: Cofinity Commercial |
$1,348.06
|
| Rate for Payer: Cofinity Commercial |
$1,656.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,348.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.64
|
| Rate for Payer: Healthscope Commercial |
$1,733.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.93
|
| Rate for Payer: PHP Commercial |
$1,636.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.77
|
| Rate for Payer: Priority Health SBD |
$1,213.25
|
|
|
HC EXTENSION KIT
|
Facility
|
OP
|
$2,031.98
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.79 |
| Max. Negotiated Rate |
$1,828.78 |
| Rate for Payer: Aetna Commercial |
$1,727.18
|
| Rate for Payer: Aetna Medicare |
$1,015.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.79
|
| Rate for Payer: BCBS Complete |
$812.79
|
| Rate for Payer: Cash Price |
$1,625.58
|
| Rate for Payer: Cofinity Commercial |
$1,422.39
|
| Rate for Payer: Cofinity Commercial |
$1,747.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,422.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.58
|
| Rate for Payer: Healthscope Commercial |
$1,828.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.18
|
| Rate for Payer: PHP Commercial |
$1,727.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.79
|
| Rate for Payer: Priority Health SBD |
$1,280.15
|
|
|
HC EXTENSION KIT
|
Facility
|
IP
|
$2,031.98
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.15 |
| Max. Negotiated Rate |
$1,828.78 |
| Rate for Payer: Aetna Commercial |
$1,727.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.79
|
| Rate for Payer: Cash Price |
$1,625.58
|
| Rate for Payer: Cofinity Commercial |
$1,422.39
|
| Rate for Payer: Cofinity Commercial |
$1,747.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,422.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.58
|
| Rate for Payer: Healthscope Commercial |
$1,828.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.18
|
| Rate for Payer: PHP Commercial |
$1,727.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.79
|
| Rate for Payer: Priority Health SBD |
$1,280.15
|
|
