|
HC PTCRAWPTCA VES/BRANCH
|
Facility
|
IP
|
$15,389.41
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,695.33 |
| Max. Negotiated Rate |
$13,850.47 |
| Rate for Payer: Aetna Commercial |
$13,081.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,003.12
|
| Rate for Payer: Cash Price |
$12,311.53
|
| Rate for Payer: Cofinity Commercial |
$10,772.59
|
| Rate for Payer: Cofinity Commercial |
$13,234.89
|
| Rate for Payer: Healthscope Commercial |
$13,850.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,081.00
|
| Rate for Payer: PHP Commercial |
$13,081.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,772.59
|
| Rate for Payer: Priority Health SBD |
$9,695.33
|
|
|
HC PTCRAWPTCA VES/BRANCH
|
Facility
|
OP
|
$15,389.41
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$603.48 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$13,081.00
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,003.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$618.62
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$12,311.53
|
| Rate for Payer: Cash Price |
$12,311.53
|
| Rate for Payer: Cofinity Commercial |
$10,772.59
|
| Rate for Payer: Cofinity Commercial |
$13,234.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$13,850.47
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,081.00
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$13,081.00
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,772.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$9,695.33
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.83
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$603.48
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
OP
|
$18,727.35
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$797.03 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,172.78
|
| Rate for Payer: BCBS Complete |
$7,490.94
|
| Rate for Payer: BCBS Trust/PPO |
$797.03
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$13,109.14
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health SBD |
$11,798.23
|
| Rate for Payer: UHC Core |
$7,632.00
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
IP
|
$18,727.35
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,798.23 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,172.78
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$13,109.14
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health SBD |
$11,798.23
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
OP
|
$28,586.86
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$631.31 |
| Max. Negotiated Rate |
$51,507.72 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: Aetna Medicare |
$16,226.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,581.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,503.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,503.28
|
| Rate for Payer: BCBS Complete |
$8,962.14
|
| Rate for Payer: BCBS MAPPO |
$15,602.62
|
| Rate for Payer: BCBS Trust/PPO |
$646.26
|
| Rate for Payer: BCN Medicare Advantage |
$15,602.62
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$20,010.80
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,602.62
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Mclaren Medicaid |
$8,534.63
|
| Rate for Payer: Mclaren Medicare |
$15,602.62
|
| Rate for Payer: Meridian Medicaid |
$8,962.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,382.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,943.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PACE Medicare |
$14,822.49
|
| Rate for Payer: PACE SWMI |
$15,602.62
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: PHP Medicare Advantage |
$15,602.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,534.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,507.72
|
| Rate for Payer: Priority Health Medicare |
$15,602.62
|
| Rate for Payer: Priority Health Narrow Network |
$41,206.18
|
| Rate for Payer: Priority Health SBD |
$18,009.72
|
| Rate for Payer: Railroad Medicare Medicare |
$15,602.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$694.44
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Exchange |
$631.31
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
IP
|
$28,586.86
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,009.72 |
| Max. Negotiated Rate |
$25,728.17 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,581.46
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$20,010.80
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health SBD |
$18,009.72
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$308.55
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$277.70 |
| Rate for Payer: Aetna Commercial |
$262.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.56
|
| Rate for Payer: BCBS Complete |
$123.42
|
| Rate for Payer: BCBS Trust/PPO |
$55.90
|
| Rate for Payer: Cash Price |
$246.84
|
| Rate for Payer: Cash Price |
$246.84
|
| Rate for Payer: Cofinity Commercial |
$265.35
|
| Rate for Payer: Cofinity Commercial |
$215.98
|
| Rate for Payer: Healthscope Commercial |
$277.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.27
|
| Rate for Payer: PHP Commercial |
$262.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.98
|
| Rate for Payer: Priority Health SBD |
$194.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.42
|
| Rate for Payer: UHC Exchange |
$98.56
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$308.55
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$277.70 |
| Rate for Payer: Aetna Commercial |
$262.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.56
|
| Rate for Payer: Cash Price |
$246.84
|
| Rate for Payer: Cofinity Commercial |
$215.98
|
| Rate for Payer: Cofinity Commercial |
$265.35
|
| Rate for Payer: Healthscope Commercial |
$277.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.27
|
| Rate for Payer: PHP Commercial |
$262.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.98
|
| Rate for Payer: Priority Health SBD |
$194.39
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$252.45
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$227.20 |
| Rate for Payer: Aetna Commercial |
$214.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.09
|
| Rate for Payer: BCBS Complete |
$100.98
|
| Rate for Payer: BCBS Trust/PPO |
$55.90
|
| Rate for Payer: Cash Price |
$201.96
|
| Rate for Payer: Cash Price |
$201.96
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$217.11
|
| Rate for Payer: Healthscope Commercial |
$227.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.58
|
| Rate for Payer: PHP Commercial |
$214.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.72
|
| Rate for Payer: Priority Health SBD |
$159.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.42
|
| Rate for Payer: UHC Exchange |
$98.56
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$252.45
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$159.04 |
| Max. Negotiated Rate |
$227.20 |
| Rate for Payer: Aetna Commercial |
$214.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.09
|
| Rate for Payer: Cash Price |
$201.96
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$217.11
|
| Rate for Payer: Healthscope Commercial |
$227.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.58
|
| Rate for Payer: PHP Commercial |
$214.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.72
|
| Rate for Payer: Priority Health SBD |
$159.04
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$55.90
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: Priority Health SBD |
$176.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.42
|
| Rate for Payer: UHC Exchange |
$98.56
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: Priority Health SBD |
$176.72
|
|
|
HC PT MIX 1:1
|
Facility
|
OP
|
$69.06
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$62.15 |
| Rate for Payer: Aetna Commercial |
$58.70
|
| Rate for Payer: Aetna Medicare |
$4.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.92
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: BCBS MAPPO |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.09
|
| Rate for Payer: BCN Medicare Advantage |
$3.94
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cofinity Commercial |
$59.39
|
| Rate for Payer: Cofinity Commercial |
$48.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$62.15
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Mclaren Medicare |
$3.94
|
| Rate for Payer: Meridian Medicaid |
$2.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.70
|
| Rate for Payer: PACE Medicare |
$3.74
|
| Rate for Payer: PACE SWMI |
$3.94
|
| Rate for Payer: PHP Commercial |
$58.70
|
| Rate for Payer: PHP Medicare Advantage |
$3.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: Priority Health SBD |
$43.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.73
|
| Rate for Payer: UHC Core |
$6.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.94
|
| Rate for Payer: UHC Exchange |
$3.94
|
| Rate for Payer: UHC Medicare Advantage |
$4.06
|
| Rate for Payer: VA VA |
$3.94
|
|
|
HC PT MIX 1:1
|
Facility
|
IP
|
$69.06
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$43.51 |
| Max. Negotiated Rate |
$62.15 |
| Rate for Payer: Aetna Commercial |
$58.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.89
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cofinity Commercial |
$48.34
|
| Rate for Payer: Cofinity Commercial |
$59.39
|
| Rate for Payer: Healthscope Commercial |
$62.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.70
|
| Rate for Payer: PHP Commercial |
$58.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health SBD |
$43.51
|
|
|
HC PT NEUROSTIM
|
Facility
|
IP
|
$95.24
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$85.72 |
| Rate for Payer: Aetna Commercial |
$80.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.91
|
| Rate for Payer: Cash Price |
$76.19
|
| Rate for Payer: Cofinity Commercial |
$66.67
|
| Rate for Payer: Cofinity Commercial |
$81.91
|
| Rate for Payer: Healthscope Commercial |
$85.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.95
|
| Rate for Payer: PHP Commercial |
$80.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.67
|
| Rate for Payer: Priority Health SBD |
$60.00
|
|
|
HC PT NEUROSTIM
|
Facility
|
OP
|
$95.24
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$85.72 |
| Rate for Payer: Aetna Commercial |
$80.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.91
|
| Rate for Payer: BCBS Complete |
$38.10
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: Cash Price |
$76.19
|
| Rate for Payer: Cash Price |
$76.19
|
| Rate for Payer: Cofinity Commercial |
$66.67
|
| Rate for Payer: Cofinity Commercial |
$81.91
|
| Rate for Payer: Healthscope Commercial |
$85.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.95
|
| Rate for Payer: PHP Commercial |
$80.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.67
|
| Rate for Payer: Priority Health SBD |
$60.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.49
|
| Rate for Payer: UHC Exchange |
$14.08
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$125.65
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$79.16 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$106.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.67
|
| Rate for Payer: Cash Price |
$100.52
|
| Rate for Payer: Cofinity Commercial |
$108.06
|
| Rate for Payer: Cofinity Commercial |
$87.96
|
| Rate for Payer: Healthscope Commercial |
$113.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.80
|
| Rate for Payer: PHP Commercial |
$106.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.96
|
| Rate for Payer: Priority Health SBD |
$79.16
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$125.65
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$106.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.67
|
| Rate for Payer: BCBS Complete |
$50.26
|
| Rate for Payer: BCBS Trust/PPO |
$38.42
|
| Rate for Payer: Cash Price |
$100.52
|
| Rate for Payer: Cash Price |
$100.52
|
| Rate for Payer: Cofinity Commercial |
$87.96
|
| Rate for Payer: Cofinity Commercial |
$108.06
|
| Rate for Payer: Healthscope Commercial |
$113.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.80
|
| Rate for Payer: PHP Commercial |
$106.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.96
|
| Rate for Payer: Priority Health SBD |
$79.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.28
|
| Rate for Payer: UHC Exchange |
$68.44
|
|
|
HC PULM EXER FUNCTION INDIV 15 MIN
|
Facility
|
IP
|
$85.96
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
41000045
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$54.15 |
| Max. Negotiated Rate |
$77.36 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.87
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$60.17
|
| Rate for Payer: Cofinity Commercial |
$73.93
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.07
|
| Rate for Payer: PHP Commercial |
$73.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.17
|
| Rate for Payer: Priority Health SBD |
$54.15
|
|
|
HC PULM EXER FUNCTION INDIV 15 MIN
|
Facility
|
OP
|
$85.96
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
41000045
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$77.36 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.11
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$60.17
|
| Rate for Payer: Cofinity Commercial |
$73.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: Mclaren Medicaid |
$14.49
|
| Rate for Payer: Mclaren Medicare |
$26.49
|
| Rate for Payer: Meridian Medicaid |
$15.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.07
|
| Rate for Payer: PACE Medicare |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$73.07
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.83
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health Narrow Network |
$59.86
|
| Rate for Payer: Priority Health SBD |
$54.15
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.49
|
| Rate for Payer: UHC Exchange |
$10.15
|
| Rate for Payer: UHC Medicare Advantage |
$27.28
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC PULMONARY ARTERIOGRAM NONSELECTIVE
|
Facility
|
OP
|
$1,667.83
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
32000197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.29 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$1,417.66
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$136.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$1,334.26
|
| Rate for Payer: Cash Price |
$1,334.26
|
| Rate for Payer: Cofinity Commercial |
$1,167.48
|
| Rate for Payer: Cofinity Commercial |
$1,434.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$1,501.05
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,417.66
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$1,417.66
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$1,050.73
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$132.29
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC PULMONARY ARTERIOGRAM NONSELECTIVE
|
Facility
|
IP
|
$1,667.83
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
32000197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,050.73 |
| Max. Negotiated Rate |
$1,501.05 |
| Rate for Payer: Aetna Commercial |
$1,417.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.09
|
| Rate for Payer: Cash Price |
$1,334.26
|
| Rate for Payer: Cofinity Commercial |
$1,167.48
|
| Rate for Payer: Cofinity Commercial |
$1,434.33
|
| Rate for Payer: Healthscope Commercial |
$1,501.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,417.66
|
| Rate for Payer: PHP Commercial |
$1,417.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.48
|
| Rate for Payer: Priority Health SBD |
$1,050.73
|
|
|
HC PULMONARY EXERCISE GROUP
|
Facility
|
IP
|
$103.14
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$92.83 |
| Rate for Payer: Aetna Commercial |
$87.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.04
|
| Rate for Payer: Cash Price |
$82.51
|
| Rate for Payer: Cofinity Commercial |
$72.20
|
| Rate for Payer: Cofinity Commercial |
$88.70
|
| Rate for Payer: Healthscope Commercial |
$92.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.67
|
| Rate for Payer: PHP Commercial |
$87.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.20
|
| Rate for Payer: Priority Health SBD |
$64.98
|
|
|
HC PULMONARY EXERCISE GROUP
|
Facility
|
OP
|
$103.14
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$101.83 |
| Rate for Payer: Aetna Commercial |
$87.67
|
| Rate for Payer: Aetna Medicare |
$37.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.60
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$35.68
|
| Rate for Payer: BCBS Trust/PPO |
$56.81
|
| Rate for Payer: BCN Medicare Advantage |
$35.68
|
| Rate for Payer: Cash Price |
$82.51
|
| Rate for Payer: Cash Price |
$82.51
|
| Rate for Payer: Cofinity Commercial |
$88.70
|
| Rate for Payer: Cofinity Commercial |
$72.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.68
|
| Rate for Payer: Healthscope Commercial |
$92.83
|
| Rate for Payer: Mclaren Medicaid |
$19.52
|
| Rate for Payer: Mclaren Medicare |
$35.68
|
| Rate for Payer: Meridian Medicaid |
$20.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.67
|
| Rate for Payer: PACE Medicare |
$33.90
|
| Rate for Payer: PACE SWMI |
$35.68
|
| Rate for Payer: PHP Commercial |
$87.67
|
| Rate for Payer: PHP Medicare Advantage |
$35.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.83
|
| Rate for Payer: Priority Health Medicare |
$35.68
|
| Rate for Payer: Priority Health Narrow Network |
$81.46
|
| Rate for Payer: Priority Health SBD |
$64.98
|
| Rate for Payer: Railroad Medicare Medicare |
$35.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.68
|
| Rate for Payer: UHC Exchange |
$12.77
|
| Rate for Payer: UHC Medicare Advantage |
$36.75
|
| Rate for Payer: VA VA |
$35.68
|
|
|
HC PULMONARY STRESS TESTING (EG 6 MIN WALK)
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
46000030
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$53.73
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Cofinity Commercial |
$255.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.85
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$229.65
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$33.40
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
