|
HC RAVAS CTO/DES
|
Facility
|
IP
|
$30,266.82
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
48100088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$19,068.10 |
| Max. Negotiated Rate |
$27,240.14 |
| Rate for Payer: Aetna Commercial |
$25,726.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,673.43
|
| Rate for Payer: Cash Price |
$24,213.46
|
| Rate for Payer: Cofinity Advantage |
$21,186.77
|
| Rate for Payer: Cofinity Commercial |
$26,029.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,213.46
|
| Rate for Payer: Healthscope Commercial |
$27,240.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,726.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,700.12
|
| Rate for Payer: PHP Commercial |
$25,726.80
|
| Rate for Payer: Priority Health SBD |
$19,068.10
|
|
|
HC RAVAS CTO/STENT
|
Facility
|
IP
|
$30,266.82
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$19,068.10 |
| Max. Negotiated Rate |
$27,240.14 |
| Rate for Payer: Aetna Commercial |
$25,726.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,673.43
|
| Rate for Payer: Cash Price |
$24,213.46
|
| Rate for Payer: Cofinity Advantage |
$21,186.77
|
| Rate for Payer: Cofinity Commercial |
$26,029.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,213.46
|
| Rate for Payer: Healthscope Commercial |
$27,240.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,726.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,700.12
|
| Rate for Payer: PHP Commercial |
$25,726.80
|
| Rate for Payer: Priority Health SBD |
$19,068.10
|
|
|
HC RAVAS CTO/STENT
|
Facility
|
OP
|
$30,266.82
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$25,726.80
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,673.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$6,394.85
|
| Rate for Payer: BCN Commercial |
$6,394.85
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$24,213.46
|
| Rate for Payer: Cash Price |
$24,213.46
|
| Rate for Payer: Cash Price |
$24,213.46
|
| Rate for Payer: Cofinity Advantage |
$21,186.77
|
| Rate for Payer: Cofinity Commercial |
$26,029.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,213.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$27,240.14
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,726.80
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,700.12
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$25,726.80
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$19,068.10
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC RBC LEUKO REDUCED
|
Facility
|
OP
|
$740.11
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$666.10 |
| Rate for Payer: Aetna Commercial |
$629.09
|
| Rate for Payer: Aetna Medicare |
$187.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.43
|
| Rate for Payer: BCBS Complete |
$99.04
|
| Rate for Payer: BCBS MAPPO |
$180.34
|
| Rate for Payer: BCBS Trust/PPO |
$505.91
|
| Rate for Payer: BCN Commercial |
$505.91
|
| Rate for Payer: BCN Medicare Advantage |
$180.34
|
| Rate for Payer: Cash Price |
$592.09
|
| Rate for Payer: Cash Price |
$592.09
|
| Rate for Payer: Cofinity Advantage |
$518.08
|
| Rate for Payer: Cofinity Commercial |
$636.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.34
|
| Rate for Payer: Healthscope Commercial |
$666.10
|
| Rate for Payer: Mclaren Medicaid |
$94.32
|
| Rate for Payer: Mclaren Medicare |
$180.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.36
|
| Rate for Payer: Meridian Medicaid |
$189.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$198.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.09
|
| Rate for Payer: Nomi Health Commercial |
$541.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.08
|
| Rate for Payer: PACE Medicare |
$171.32
|
| Rate for Payer: PACE SWMI |
$180.34
|
| Rate for Payer: PHP Commercial |
$629.09
|
| Rate for Payer: PHP Medicare Advantage |
$180.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$583.21
|
| Rate for Payer: Priority Health Medicare |
$180.34
|
| Rate for Payer: Priority Health SBD |
$466.27
|
| Rate for Payer: Priority Health Tiered Network |
$466.57
|
| Rate for Payer: Railroad Medicare Medicare |
$180.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$481.07
|
| Rate for Payer: UHC Core |
$385.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$180.34
|
| Rate for Payer: UHC Exchange |
$290.86
|
| Rate for Payer: UHC Medicaid |
$94.32
|
| Rate for Payer: UHCCP Medicaid |
$94.32
|
| Rate for Payer: VA VA |
$180.34
|
|
|
HC RBC LEUKO REDUCED
|
Facility
|
IP
|
$740.11
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$466.27 |
| Max. Negotiated Rate |
$666.10 |
| Rate for Payer: Aetna Commercial |
$629.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.07
|
| Rate for Payer: Cash Price |
$592.09
|
| Rate for Payer: Cofinity Advantage |
$518.08
|
| Rate for Payer: Cofinity Commercial |
$636.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.09
|
| Rate for Payer: Healthscope Commercial |
$666.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.08
|
| Rate for Payer: PHP Commercial |
$629.09
|
| Rate for Payer: Priority Health SBD |
$466.27
|
|
|
HC RBC LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$1,282.23
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000072
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$807.80 |
| Max. Negotiated Rate |
$1,154.01 |
| Rate for Payer: Aetna Commercial |
$1,089.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$833.45
|
| Rate for Payer: Cash Price |
$1,025.78
|
| Rate for Payer: Cofinity Advantage |
$897.56
|
| Rate for Payer: Cofinity Commercial |
$1,102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,025.78
|
| Rate for Payer: Healthscope Commercial |
$1,154.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,089.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$961.67
|
| Rate for Payer: PHP Commercial |
$1,089.90
|
| Rate for Payer: Priority Health SBD |
$807.80
|
|
|
HC RBC LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$1,282.23
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000072
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$135.38 |
| Max. Negotiated Rate |
$1,154.01 |
| Rate for Payer: Aetna Commercial |
$1,089.90
|
| Rate for Payer: Aetna Medicare |
$269.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$833.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.56
|
| Rate for Payer: BCBS Complete |
$142.16
|
| Rate for Payer: BCBS MAPPO |
$258.85
|
| Rate for Payer: BCBS Trust/PPO |
$711.05
|
| Rate for Payer: BCN Commercial |
$711.05
|
| Rate for Payer: BCN Medicare Advantage |
$258.85
|
| Rate for Payer: Cash Price |
$1,025.78
|
| Rate for Payer: Cash Price |
$1,025.78
|
| Rate for Payer: Cofinity Advantage |
$897.56
|
| Rate for Payer: Cofinity Commercial |
$1,102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,025.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.85
|
| Rate for Payer: Healthscope Commercial |
$1,154.01
|
| Rate for Payer: Mclaren Medicaid |
$135.38
|
| Rate for Payer: Mclaren Medicare |
$258.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.79
|
| Rate for Payer: Meridian Medicaid |
$271.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$284.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,089.90
|
| Rate for Payer: Nomi Health Commercial |
$776.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$961.67
|
| Rate for Payer: PACE Medicare |
$245.91
|
| Rate for Payer: PACE SWMI |
$258.85
|
| Rate for Payer: PHP Commercial |
$1,089.90
|
| Rate for Payer: PHP Medicare Advantage |
$258.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$837.08
|
| Rate for Payer: Priority Health Medicare |
$258.85
|
| Rate for Payer: Priority Health SBD |
$807.80
|
| Rate for Payer: Priority Health Tiered Network |
$669.66
|
| Rate for Payer: Railroad Medicare Medicare |
$258.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$833.45
|
| Rate for Payer: UHC Core |
$668.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$258.85
|
| Rate for Payer: UHC Exchange |
$503.92
|
| Rate for Payer: UHC Medicaid |
$135.38
|
| Rate for Payer: UHCCP Medicaid |
$135.38
|
| Rate for Payer: VA VA |
$258.85
|
|
|
HC RECEPTOR ASSAY OTHER ENDOCRINE
|
Facility
|
IP
|
$208.05
|
|
|
Service Code
|
CPT 84235
|
| Hospital Charge Code |
30100418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.07 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.23
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Advantage |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$187.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.04
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health SBD |
$131.07
|
|
|
HC RECEPTOR ASSAY OTHER ENDOCRINE
|
Facility
|
OP
|
$208.05
|
|
|
Service Code
|
CPT 84235
|
| Hospital Charge Code |
30100418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna Medicare |
$74.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.04
|
| Rate for Payer: BCBS Complete |
$39.12
|
| Rate for Payer: BCBS MAPPO |
$71.23
|
| Rate for Payer: BCBS Trust/PPO |
$75.94
|
| Rate for Payer: BCN Commercial |
$75.94
|
| Rate for Payer: BCN Medicare Advantage |
$71.23
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Advantage |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.23
|
| Rate for Payer: Healthscope Commercial |
$187.25
|
| Rate for Payer: Mclaren Medicaid |
$37.25
|
| Rate for Payer: Mclaren Medicare |
$71.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.79
|
| Rate for Payer: Meridian Medicaid |
$74.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$106.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.04
|
| Rate for Payer: PACE Medicare |
$67.67
|
| Rate for Payer: PACE SWMI |
$71.23
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: PHP Medicare Advantage |
$71.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$71.23
|
| Rate for Payer: Priority Health Medicare |
$71.23
|
| Rate for Payer: Priority Health SBD |
$131.07
|
| Rate for Payer: Priority Health Tiered Network |
$56.98
|
| Rate for Payer: Railroad Medicare Medicare |
$71.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.85
|
| Rate for Payer: UHC Core |
$106.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.23
|
| Rate for Payer: UHC Exchange |
$106.85
|
| Rate for Payer: UHC Medicaid |
$37.25
|
| Rate for Payer: UHCCP Medicaid |
$37.25
|
| Rate for Payer: VA VA |
$71.23
|
|
|
HC RECOVERY 1 ADD'L 15 MIN
|
Facility
|
OP
|
$160.15
|
|
| Hospital Charge Code |
71000020
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$62.94 |
| Max. Negotiated Rate |
$144.13 |
| Rate for Payer: Aetna Commercial |
$136.13
|
| Rate for Payer: Aetna Medicare |
$80.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.10
|
| Rate for Payer: BCBS Complete |
$64.06
|
| Rate for Payer: Cash Price |
$128.12
|
| Rate for Payer: Cofinity Advantage |
$112.11
|
| Rate for Payer: Cofinity Commercial |
$137.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.12
|
| Rate for Payer: Healthscope Commercial |
$144.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.11
|
| Rate for Payer: PHP Commercial |
$136.13
|
| Rate for Payer: Priority Health SBD |
$100.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.10
|
| Rate for Payer: UHC Core |
$83.44
|
| Rate for Payer: UHC Exchange |
$62.94
|
|
|
HC RECOVERY 1 ADD'L 15 MIN
|
Facility
|
IP
|
$160.15
|
|
| Hospital Charge Code |
71000020
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$100.89 |
| Max. Negotiated Rate |
$144.13 |
| Rate for Payer: Aetna Commercial |
$136.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.10
|
| Rate for Payer: Cash Price |
$128.12
|
| Rate for Payer: Cofinity Advantage |
$112.11
|
| Rate for Payer: Cofinity Commercial |
$137.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.12
|
| Rate for Payer: Healthscope Commercial |
$144.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.11
|
| Rate for Payer: PHP Commercial |
$136.13
|
| Rate for Payer: Priority Health SBD |
$100.89
|
|
|
HC RECOVERY 1 BASE CHARGE
|
Facility
|
OP
|
$118.32
|
|
| Hospital Charge Code |
71000039
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$106.49 |
| Rate for Payer: Aetna Commercial |
$100.57
|
| Rate for Payer: Aetna Medicare |
$59.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.91
|
| Rate for Payer: BCBS Complete |
$47.33
|
| Rate for Payer: Cash Price |
$94.66
|
| Rate for Payer: Cofinity Advantage |
$82.82
|
| Rate for Payer: Cofinity Commercial |
$101.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.66
|
| Rate for Payer: Healthscope Commercial |
$106.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.74
|
| Rate for Payer: PHP Commercial |
$100.57
|
| Rate for Payer: Priority Health SBD |
$74.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.91
|
| Rate for Payer: UHC Core |
$61.64
|
| Rate for Payer: UHC Exchange |
$46.50
|
|
|
HC RECOVERY 1 BASE CHARGE
|
Facility
|
IP
|
$118.32
|
|
| Hospital Charge Code |
71000039
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$74.54 |
| Max. Negotiated Rate |
$106.49 |
| Rate for Payer: Aetna Commercial |
$100.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.91
|
| Rate for Payer: Cash Price |
$94.66
|
| Rate for Payer: Cofinity Advantage |
$82.82
|
| Rate for Payer: Cofinity Commercial |
$101.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.66
|
| Rate for Payer: Healthscope Commercial |
$106.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.74
|
| Rate for Payer: PHP Commercial |
$100.57
|
| Rate for Payer: Priority Health SBD |
$74.54
|
|
|
HC RECOVERY 1 EA MIN
|
Facility
|
OP
|
$15.30
|
|
| Hospital Charge Code |
71000034
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.01
|
| Rate for Payer: Aetna Medicare |
$7.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.95
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Advantage |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.47
|
| Rate for Payer: PHP Commercial |
$13.01
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.95
|
| Rate for Payer: UHC Core |
$7.97
|
| Rate for Payer: UHC Exchange |
$6.01
|
|
|
HC RECOVERY 1 EA MIN
|
Facility
|
IP
|
$15.30
|
|
| Hospital Charge Code |
71000034
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.95
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Advantage |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.47
|
| Rate for Payer: PHP Commercial |
$13.01
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC RECOVERY 1 INIT 30 MIN
|
Facility
|
IP
|
$378.09
|
|
| Hospital Charge Code |
71000021
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$340.28 |
| Rate for Payer: Aetna Commercial |
$321.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.76
|
| Rate for Payer: Cash Price |
$302.47
|
| Rate for Payer: Cofinity Advantage |
$264.66
|
| Rate for Payer: Cofinity Commercial |
$325.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.47
|
| Rate for Payer: Healthscope Commercial |
$340.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.57
|
| Rate for Payer: PHP Commercial |
$321.38
|
| Rate for Payer: Priority Health SBD |
$238.20
|
|
|
HC RECOVERY 1 INIT 30 MIN
|
Facility
|
OP
|
$378.09
|
|
| Hospital Charge Code |
71000021
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$148.59 |
| Max. Negotiated Rate |
$340.28 |
| Rate for Payer: Aetna Commercial |
$321.38
|
| Rate for Payer: Aetna Medicare |
$189.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.76
|
| Rate for Payer: BCBS Complete |
$151.24
|
| Rate for Payer: Cash Price |
$302.47
|
| Rate for Payer: Cofinity Advantage |
$264.66
|
| Rate for Payer: Cofinity Commercial |
$325.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.47
|
| Rate for Payer: Healthscope Commercial |
$340.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.57
|
| Rate for Payer: PHP Commercial |
$321.38
|
| Rate for Payer: Priority Health SBD |
$238.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.76
|
| Rate for Payer: UHC Core |
$196.98
|
| Rate for Payer: UHC Exchange |
$148.59
|
|
|
HC RECOVERY 2 ADD'L 15 MIN
|
Facility
|
IP
|
$187.51
|
|
| Hospital Charge Code |
71000022
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$118.13 |
| Max. Negotiated Rate |
$168.76 |
| Rate for Payer: Aetna Commercial |
$159.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.88
|
| Rate for Payer: Cash Price |
$150.01
|
| Rate for Payer: Cofinity Advantage |
$131.26
|
| Rate for Payer: Cofinity Commercial |
$161.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.01
|
| Rate for Payer: Healthscope Commercial |
$168.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.63
|
| Rate for Payer: PHP Commercial |
$159.38
|
| Rate for Payer: Priority Health SBD |
$118.13
|
|
|
HC RECOVERY 2 ADD'L 15 MIN
|
Facility
|
OP
|
$187.51
|
|
| Hospital Charge Code |
71000022
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$73.69 |
| Max. Negotiated Rate |
$168.76 |
| Rate for Payer: Aetna Commercial |
$159.38
|
| Rate for Payer: Aetna Medicare |
$93.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.88
|
| Rate for Payer: BCBS Complete |
$75.00
|
| Rate for Payer: Cash Price |
$150.01
|
| Rate for Payer: Cofinity Advantage |
$131.26
|
| Rate for Payer: Cofinity Commercial |
$161.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.01
|
| Rate for Payer: Healthscope Commercial |
$168.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.63
|
| Rate for Payer: PHP Commercial |
$159.38
|
| Rate for Payer: Priority Health SBD |
$118.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.88
|
| Rate for Payer: UHC Core |
$97.69
|
| Rate for Payer: UHC Exchange |
$73.69
|
|
|
HC RECOVERY 2 BASE CHARGE
|
Facility
|
IP
|
$98.94
|
|
| Hospital Charge Code |
71000035
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$62.33 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Aetna Commercial |
$84.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.31
|
| Rate for Payer: Cash Price |
$79.15
|
| Rate for Payer: Cofinity Advantage |
$69.26
|
| Rate for Payer: Cofinity Commercial |
$85.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.15
|
| Rate for Payer: Healthscope Commercial |
$89.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.20
|
| Rate for Payer: PHP Commercial |
$84.10
|
| Rate for Payer: Priority Health SBD |
$62.33
|
|
|
HC RECOVERY 2 BASE CHARGE
|
Facility
|
OP
|
$98.94
|
|
| Hospital Charge Code |
71000035
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Aetna Commercial |
$84.10
|
| Rate for Payer: Aetna Medicare |
$49.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.31
|
| Rate for Payer: BCBS Complete |
$39.58
|
| Rate for Payer: Cash Price |
$79.15
|
| Rate for Payer: Cofinity Advantage |
$69.26
|
| Rate for Payer: Cofinity Commercial |
$85.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.15
|
| Rate for Payer: Healthscope Commercial |
$89.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.20
|
| Rate for Payer: PHP Commercial |
$84.10
|
| Rate for Payer: Priority Health SBD |
$62.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.31
|
| Rate for Payer: UHC Core |
$51.55
|
| Rate for Payer: UHC Exchange |
$38.88
|
|
|
HC RECOVERY 2 EA MIN
|
Facility
|
IP
|
$12.24
|
|
| Hospital Charge Code |
71000036
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Advantage |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health SBD |
$7.71
|
|
|
HC RECOVERY 2 EA MIN
|
Facility
|
OP
|
$12.24
|
|
| Hospital Charge Code |
71000036
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Advantage |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.18
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.96
|
| Rate for Payer: UHC Core |
$6.38
|
| Rate for Payer: UHC Exchange |
$4.81
|
|
|
HC RECOVERY 2 INIT 30 MIN
|
Facility
|
IP
|
$338.20
|
|
| Hospital Charge Code |
71000023
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$213.07 |
| Max. Negotiated Rate |
$304.38 |
| Rate for Payer: Aetna Commercial |
$287.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.83
|
| Rate for Payer: Cash Price |
$270.56
|
| Rate for Payer: Cofinity Advantage |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$290.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.56
|
| Rate for Payer: Healthscope Commercial |
$304.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.65
|
| Rate for Payer: PHP Commercial |
$287.47
|
| Rate for Payer: Priority Health SBD |
$213.07
|
|
|
HC RECOVERY 2 INIT 30 MIN
|
Facility
|
OP
|
$338.20
|
|
| Hospital Charge Code |
71000023
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$132.91 |
| Max. Negotiated Rate |
$304.38 |
| Rate for Payer: Aetna Commercial |
$287.47
|
| Rate for Payer: Aetna Medicare |
$169.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.83
|
| Rate for Payer: BCBS Complete |
$135.28
|
| Rate for Payer: Cash Price |
$270.56
|
| Rate for Payer: Cofinity Advantage |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$290.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.56
|
| Rate for Payer: Healthscope Commercial |
$304.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.65
|
| Rate for Payer: PHP Commercial |
$287.47
|
| Rate for Payer: Priority Health SBD |
$213.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.83
|
| Rate for Payer: UHC Core |
$176.20
|
| Rate for Payer: UHC Exchange |
$132.91
|
|
