|
HC PULM EXER FUNCTION INDIV 15 MIN
|
Facility
|
IP
|
$87.68
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
41000045
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$55.24 |
| Max. Negotiated Rate |
$78.91 |
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.99
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$61.38
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health SBD |
$55.24
|
|
|
HC PULM EXER FUNCTION INDIV 15 MIN
|
Facility
|
OP
|
$87.68
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
41000045
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$78.91 |
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Cofinity Commercial |
$61.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health SBD |
$55.24
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Core |
$64.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$64.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$13.44
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC PULMONARY ARTERIOGRAM NONSELECTIVE
|
Facility
|
OP
|
$1,701.19
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
32000197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,071.75 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$1,446.01
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,105.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$1,360.95
|
| Rate for Payer: Cash Price |
$1,360.95
|
| Rate for Payer: Cofinity Commercial |
$1,463.02
|
| Rate for Payer: Cofinity Commercial |
$1,190.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,190.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$1,531.07
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,446.01
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$1,446.01
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.77
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$1,071.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Core |
$1,258.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$1,258.88
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC PULMONARY ARTERIOGRAM NONSELECTIVE
|
Facility
|
IP
|
$1,701.19
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
32000197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,071.75 |
| Max. Negotiated Rate |
$1,531.07 |
| Rate for Payer: Aetna Commercial |
$1,446.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,105.77
|
| Rate for Payer: Cash Price |
$1,360.95
|
| Rate for Payer: Cofinity Commercial |
$1,190.83
|
| Rate for Payer: Cofinity Commercial |
$1,463.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,190.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.95
|
| Rate for Payer: Healthscope Commercial |
$1,531.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,446.01
|
| Rate for Payer: PHP Commercial |
$1,446.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.77
|
| Rate for Payer: Priority Health SBD |
$1,071.75
|
|
|
HC PULMONARY EXERCISE GROUP
|
Facility
|
OP
|
$105.20
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna Commercial |
$89.42
|
| Rate for Payer: Aetna Medicare |
$39.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$84.16
|
| Rate for Payer: Cash Price |
$84.16
|
| Rate for Payer: Cofinity Commercial |
$90.47
|
| Rate for Payer: Cofinity Commercial |
$73.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$94.68
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.42
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$89.42
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.38
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health SBD |
$66.28
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.75
|
| Rate for Payer: UHC Core |
$77.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Exchange |
$77.85
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$21.55
|
| Rate for Payer: VA VA |
$38.28
|
|
|
HC PULMONARY EXERCISE GROUP
|
Facility
|
IP
|
$105.20
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.28 |
| Max. Negotiated Rate |
$94.68 |
| Rate for Payer: Aetna Commercial |
$89.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.38
|
| Rate for Payer: Cash Price |
$84.16
|
| Rate for Payer: Cofinity Commercial |
$73.64
|
| Rate for Payer: Cofinity Commercial |
$90.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.16
|
| Rate for Payer: Healthscope Commercial |
$94.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.42
|
| Rate for Payer: PHP Commercial |
$89.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.38
|
| Rate for Payer: Priority Health SBD |
$66.28
|
|
|
HC PULMONARY STRESS TESTING (EG 6 MIN WALK)
|
Facility
|
OP
|
$371.82
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
46000030
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$316.05
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$297.46
|
| Rate for Payer: Cash Price |
$297.46
|
| Rate for Payer: Cofinity Commercial |
$319.77
|
| Rate for Payer: Cofinity Commercial |
$260.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$334.64
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.05
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$316.05
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$234.25
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Core |
$275.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$275.15
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC PULMONARY STRESS TESTING (EG 6 MIN WALK)
|
Facility
|
IP
|
$371.82
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
46000030
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$234.25 |
| Max. Negotiated Rate |
$334.64 |
| Rate for Payer: Aetna Commercial |
$316.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.68
|
| Rate for Payer: Cash Price |
$297.46
|
| Rate for Payer: Cofinity Commercial |
$260.27
|
| Rate for Payer: Cofinity Commercial |
$319.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.46
|
| Rate for Payer: Healthscope Commercial |
$334.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.05
|
| Rate for Payer: PHP Commercial |
$316.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: Priority Health SBD |
$234.25
|
|
|
HC PULM REHAB W/ CONT OXIMTRY MNTR
|
Facility
|
OP
|
$219.58
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
94800004
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$197.62 |
| Rate for Payer: Aetna Commercial |
$186.64
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$175.66
|
| Rate for Payer: Cash Price |
$175.66
|
| Rate for Payer: Cofinity Commercial |
$188.84
|
| Rate for Payer: Cofinity Commercial |
$153.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$197.62
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.64
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$186.64
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.73
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$138.34
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Core |
$162.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$162.49
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC PULM REHAB W/ CONT OXIMTRY MNTR
|
Facility
|
IP
|
$219.58
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
94800004
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$138.34 |
| Max. Negotiated Rate |
$197.62 |
| Rate for Payer: Aetna Commercial |
$186.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.73
|
| Rate for Payer: Cash Price |
$175.66
|
| Rate for Payer: Cofinity Commercial |
$153.71
|
| Rate for Payer: Cofinity Commercial |
$188.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.66
|
| Rate for Payer: Healthscope Commercial |
$197.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.64
|
| Rate for Payer: PHP Commercial |
$186.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.73
|
| Rate for Payer: Priority Health SBD |
$138.34
|
|
|
HC PULM REHAB W/O CONT OXIMTRY MNTR
|
Facility
|
OP
|
$186.64
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
94800003
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$167.98 |
| Rate for Payer: Aetna Commercial |
$158.64
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$149.31
|
| Rate for Payer: Cash Price |
$149.31
|
| Rate for Payer: Cofinity Commercial |
$130.65
|
| Rate for Payer: Cofinity Commercial |
$160.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$167.98
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.64
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$158.64
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.32
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$117.58
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Core |
$138.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$138.11
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC PULM REHAB W/O CONT OXIMTRY MNTR
|
Facility
|
IP
|
$186.64
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
94800003
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$117.58 |
| Max. Negotiated Rate |
$167.98 |
| Rate for Payer: Aetna Commercial |
$158.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.32
|
| Rate for Payer: Cash Price |
$149.31
|
| Rate for Payer: Cofinity Commercial |
$130.65
|
| Rate for Payer: Cofinity Commercial |
$160.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.31
|
| Rate for Payer: Healthscope Commercial |
$167.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.64
|
| Rate for Payer: PHP Commercial |
$158.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.32
|
| Rate for Payer: Priority Health SBD |
$117.58
|
|
|
HC PULSE OXIMETRY MULTI DETER
|
Facility
|
OP
|
$128.24
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.00
|
| Rate for Payer: Aetna Medicare |
$64.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: BCBS Complete |
$51.30
|
| Rate for Payer: Cash Price |
$102.59
|
| Rate for Payer: Cofinity Commercial |
$110.29
|
| Rate for Payer: Cofinity Commercial |
$89.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.59
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.00
|
| Rate for Payer: PHP Commercial |
$109.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health SBD |
$80.79
|
| Rate for Payer: UHC Core |
$94.90
|
| Rate for Payer: UHC Exchange |
$94.90
|
|
|
HC PULSE OXIMETRY MULTI DETER
|
Facility
|
IP
|
$128.24
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$80.79 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: Cash Price |
$102.59
|
| Rate for Payer: Cofinity Commercial |
$110.29
|
| Rate for Payer: Cofinity Commercial |
$89.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.59
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.00
|
| Rate for Payer: PHP Commercial |
$109.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health SBD |
$80.79
|
|
|
HC PULSE OX OVERNIGHT
|
Facility
|
OP
|
$205.42
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
46000027
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$174.61
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$164.34
|
| Rate for Payer: Cash Price |
$164.34
|
| Rate for Payer: Cofinity Commercial |
$143.79
|
| Rate for Payer: Cofinity Commercial |
$176.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$184.88
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.61
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$174.61
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.52
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$129.41
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$152.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$152.01
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC PULSE OX OVERNIGHT
|
Facility
|
IP
|
$205.42
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
46000027
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$129.41 |
| Max. Negotiated Rate |
$184.88 |
| Rate for Payer: Aetna Commercial |
$174.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.52
|
| Rate for Payer: Cash Price |
$164.34
|
| Rate for Payer: Cofinity Commercial |
$143.79
|
| Rate for Payer: Cofinity Commercial |
$176.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.34
|
| Rate for Payer: Healthscope Commercial |
$184.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.61
|
| Rate for Payer: PHP Commercial |
$174.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.52
|
| Rate for Payer: Priority Health SBD |
$129.41
|
|
|
HC PULSE OX SINGLE
|
Facility
|
OP
|
$86.43
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$73.47
|
| Rate for Payer: Aetna Medicare |
$43.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.18
|
| Rate for Payer: BCBS Complete |
$34.57
|
| Rate for Payer: Cash Price |
$69.14
|
| Rate for Payer: Cofinity Commercial |
$60.50
|
| Rate for Payer: Cofinity Commercial |
$74.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.14
|
| Rate for Payer: Healthscope Commercial |
$77.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.47
|
| Rate for Payer: PHP Commercial |
$73.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: Priority Health SBD |
$54.45
|
| Rate for Payer: UHC Core |
$63.96
|
| Rate for Payer: UHC Exchange |
$63.96
|
|
|
HC PULSE OX SINGLE
|
Facility
|
IP
|
$86.43
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$73.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.18
|
| Rate for Payer: Cash Price |
$69.14
|
| Rate for Payer: Cofinity Commercial |
$60.50
|
| Rate for Payer: Cofinity Commercial |
$74.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.14
|
| Rate for Payer: Healthscope Commercial |
$77.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.47
|
| Rate for Payer: PHP Commercial |
$73.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: Priority Health SBD |
$54.45
|
|
|
HC PULSERIDER
|
Facility
|
OP
|
$17,069.07
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,827.63 |
| Max. Negotiated Rate |
$15,362.16 |
| Rate for Payer: Aetna Commercial |
$14,508.71
|
| Rate for Payer: Aetna Medicare |
$8,534.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,094.90
|
| Rate for Payer: BCBS Complete |
$6,827.63
|
| Rate for Payer: Cash Price |
$13,655.26
|
| Rate for Payer: Cofinity Commercial |
$11,948.35
|
| Rate for Payer: Cofinity Commercial |
$14,679.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,948.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,655.26
|
| Rate for Payer: Healthscope Commercial |
$15,362.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,508.71
|
| Rate for Payer: PHP Commercial |
$14,508.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,094.90
|
| Rate for Payer: Priority Health SBD |
$10,753.51
|
|
|
HC PULSERIDER
|
Facility
|
IP
|
$17,069.07
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,753.51 |
| Max. Negotiated Rate |
$15,362.16 |
| Rate for Payer: Aetna Commercial |
$14,508.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,094.90
|
| Rate for Payer: Cash Price |
$13,655.26
|
| Rate for Payer: Cofinity Commercial |
$11,948.35
|
| Rate for Payer: Cofinity Commercial |
$14,679.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,948.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,655.26
|
| Rate for Payer: Healthscope Commercial |
$15,362.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,508.71
|
| Rate for Payer: PHP Commercial |
$14,508.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,094.90
|
| Rate for Payer: Priority Health SBD |
$10,753.51
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
IP
|
$457.25
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$288.07 |
| Max. Negotiated Rate |
$411.52 |
| Rate for Payer: Aetna Commercial |
$388.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.21
|
| Rate for Payer: Cash Price |
$365.80
|
| Rate for Payer: Cofinity Commercial |
$320.07
|
| Rate for Payer: Cofinity Commercial |
$393.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.80
|
| Rate for Payer: Healthscope Commercial |
$411.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.66
|
| Rate for Payer: PHP Commercial |
$388.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.21
|
| Rate for Payer: Priority Health SBD |
$288.07
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
OP
|
$457.25
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$182.90 |
| Max. Negotiated Rate |
$411.52 |
| Rate for Payer: Aetna Commercial |
$388.66
|
| Rate for Payer: Aetna Medicare |
$228.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.21
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: Cash Price |
$365.80
|
| Rate for Payer: Cofinity Commercial |
$320.07
|
| Rate for Payer: Cofinity Commercial |
$393.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.80
|
| Rate for Payer: Healthscope Commercial |
$411.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.66
|
| Rate for Payer: PHP Commercial |
$388.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.21
|
| Rate for Payer: Priority Health SBD |
$288.07
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$83.55
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.64 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Commercial |
$71.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.31
|
| Rate for Payer: Cash Price |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Cofinity Commercial |
$71.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.84
|
| Rate for Payer: Healthscope Commercial |
$75.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.02
|
| Rate for Payer: PHP Commercial |
$71.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.31
|
| Rate for Payer: Priority Health SBD |
$52.64
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$83.55
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Commercial |
$71.02
|
| Rate for Payer: Aetna Medicare |
$41.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.31
|
| Rate for Payer: BCBS Complete |
$33.42
|
| Rate for Payer: Cash Price |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Cofinity Commercial |
$71.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.84
|
| Rate for Payer: Healthscope Commercial |
$75.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.02
|
| Rate for Payer: PHP Commercial |
$71.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.31
|
| Rate for Payer: Priority Health SBD |
$52.64
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$319.12
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.05 |
| Max. Negotiated Rate |
$287.21 |
| Rate for Payer: Aetna Commercial |
$271.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.43
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cofinity Commercial |
$223.38
|
| Rate for Payer: Cofinity Commercial |
$274.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.30
|
| Rate for Payer: Healthscope Commercial |
$287.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.25
|
| Rate for Payer: PHP Commercial |
$271.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.43
|
| Rate for Payer: Priority Health SBD |
$201.05
|
|
