|
HC T AND B CELL QUANTITATION CMPT2
|
Facility
|
IP
|
$61.72
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
30200202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$55.55 |
| Rate for Payer: Aetna Commercial |
$52.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.12
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.38
|
| Rate for Payer: Healthscope Commercial |
$55.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.46
|
| Rate for Payer: PHP Commercial |
$52.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.12
|
| Rate for Payer: Priority Health SBD |
$38.88
|
|
|
HC T AND B CELL QUANTITATION CMPT2
|
Facility
|
OP
|
$61.72
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
30200202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$106.21 |
| Rate for Payer: Aetna Commercial |
$52.46
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: BCBS Complete |
$21.23
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Cofinity Commercial |
$43.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$55.55
|
| Rate for Payer: Mclaren Medicaid |
$20.22
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: Meridian Medicaid |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.46
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$52.46
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.12
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$38.88
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Medicare Advantage |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$21.24
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC T AND B CELL QUANTITATION CMPT3
|
Facility
|
IP
|
$61.72
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
30200203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$55.55 |
| Rate for Payer: Aetna Commercial |
$52.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.12
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.38
|
| Rate for Payer: Healthscope Commercial |
$55.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.46
|
| Rate for Payer: PHP Commercial |
$52.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.12
|
| Rate for Payer: Priority Health SBD |
$38.88
|
|
|
HC T AND B CELL QUANTITATION CMPT3
|
Facility
|
OP
|
$61.72
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
30200203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$106.21 |
| Rate for Payer: Aetna Commercial |
$52.46
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: BCBS Complete |
$21.23
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Cofinity Commercial |
$43.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$55.55
|
| Rate for Payer: Mclaren Medicaid |
$20.22
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: Meridian Medicaid |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.46
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$52.46
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.12
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$38.88
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Medicare Advantage |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$21.24
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC T AND B CELL QUANTITATION CMPT4
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
30200512
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$75.38 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$27.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.48
|
| Rate for Payer: BCBS Complete |
$15.07
|
| Rate for Payer: BCBS MAPPO |
$26.78
|
| Rate for Payer: BCN Medicare Advantage |
$26.78
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Mclaren Medicaid |
$14.35
|
| Rate for Payer: Mclaren Medicare |
$26.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.12
|
| Rate for Payer: Meridian Medicaid |
$15.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.50
|
| Rate for Payer: PACE Medicare |
$25.44
|
| Rate for Payer: PACE SWMI |
$26.78
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: PHP Medicare Advantage |
$26.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$26.78
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: Railroad Medicare Medicare |
$26.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.78
|
| Rate for Payer: UHC Medicare Advantage |
$26.78
|
| Rate for Payer: UHCCP Medicaid |
$15.08
|
| Rate for Payer: VA VA |
$26.78
|
|
|
HC T AND B CELL QUANTITATION CMPT4
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
30200512
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC TANGENTIAL BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$83.55
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
76100149
|
|
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 TANGENTIAL BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$83.55
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
76100149
|
|
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 TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$275.71
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.70 |
| Max. Negotiated Rate |
$248.14 |
| Rate for Payer: Aetna Commercial |
$234.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.21
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cofinity Commercial |
$193.00
|
| Rate for Payer: Cofinity Commercial |
$237.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.57
|
| Rate for Payer: Healthscope Commercial |
$248.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.35
|
| Rate for Payer: PHP Commercial |
$234.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.21
|
| Rate for Payer: Priority Health SBD |
$173.70
|
|
|
HC TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$275.71
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$234.35
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cofinity Commercial |
$237.11
|
| Rate for Payer: Cofinity Commercial |
$193.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$248.14
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.35
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$234.35
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.21
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$173.70
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC TAVR CONVERTED TO ON-PUMP
|
Facility
|
OP
|
$6,525.68
|
|
| Hospital Charge Code |
27000703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,610.27 |
| Max. Negotiated Rate |
$5,873.11 |
| Rate for Payer: Aetna Commercial |
$5,546.83
|
| Rate for Payer: Aetna Medicare |
$3,262.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,241.69
|
| Rate for Payer: BCBS Complete |
$2,610.27
|
| Rate for Payer: Cash Price |
$5,220.54
|
| Rate for Payer: Cofinity Commercial |
$4,567.98
|
| Rate for Payer: Cofinity Commercial |
$5,612.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,567.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,220.54
|
| Rate for Payer: Healthscope Commercial |
$5,873.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,546.83
|
| Rate for Payer: PHP Commercial |
$5,546.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,241.69
|
| Rate for Payer: Priority Health SBD |
$4,111.18
|
|
|
HC TAVR CONVERTED TO ON-PUMP
|
Facility
|
IP
|
$6,525.68
|
|
| Hospital Charge Code |
27000703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,111.18 |
| Max. Negotiated Rate |
$5,873.11 |
| Rate for Payer: Aetna Commercial |
$5,546.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,241.69
|
| Rate for Payer: Cash Price |
$5,220.54
|
| Rate for Payer: Cofinity Commercial |
$4,567.98
|
| Rate for Payer: Cofinity Commercial |
$5,612.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,567.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,220.54
|
| Rate for Payer: Healthscope Commercial |
$5,873.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,546.83
|
| Rate for Payer: PHP Commercial |
$5,546.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,241.69
|
| Rate for Payer: Priority Health SBD |
$4,111.18
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
OP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,000.00 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Aetna Commercial |
$31,875.00
|
| Rate for Payer: Aetna Medicare |
$18,750.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,375.00
|
| Rate for Payer: BCBS Complete |
$15,000.00
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$26,250.00
|
| Rate for Payer: Cofinity Commercial |
$32,250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$26,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Healthscope Commercial |
$33,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,875.00
|
| Rate for Payer: PHP Commercial |
$31,875.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,375.00
|
| Rate for Payer: Priority Health SBD |
$23,625.00
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,625.00 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Aetna Commercial |
$31,875.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,375.00
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$26,250.00
|
| Rate for Payer: Cofinity Commercial |
$32,250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$26,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Healthscope Commercial |
$33,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,875.00
|
| Rate for Payer: PHP Commercial |
$31,875.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,375.00
|
| Rate for Payer: Priority Health SBD |
$23,625.00
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
IP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,593.75 |
| Max. Negotiated Rate |
$36,562.50 |
| Rate for Payer: Aetna Commercial |
$34,531.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,406.25
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$28,437.50
|
| Rate for Payer: Cofinity Commercial |
$34,937.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$28,437.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Healthscope Commercial |
$36,562.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,531.25
|
| Rate for Payer: PHP Commercial |
$34,531.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,406.25
|
| Rate for Payer: Priority Health SBD |
$25,593.75
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
OP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,250.00 |
| Max. Negotiated Rate |
$36,562.50 |
| Rate for Payer: Aetna Commercial |
$34,531.25
|
| Rate for Payer: Aetna Medicare |
$20,312.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,406.25
|
| Rate for Payer: BCBS Complete |
$16,250.00
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$28,437.50
|
| Rate for Payer: Cofinity Commercial |
$34,937.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$28,437.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Healthscope Commercial |
$36,562.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,531.25
|
| Rate for Payer: PHP Commercial |
$34,531.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,406.25
|
| Rate for Payer: Priority Health SBD |
$25,593.75
|
|
|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: UHC Core |
$31.70
|
| Rate for Payer: UHC Exchange |
$31.70
|
|
|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$241.72 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$157.44
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$184.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$184.93
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health SBD |
$157.44
|
|
|
HC TB TEST
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
|
|
HC TB TEST
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$67.22 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| 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 |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| 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 |
$20.81
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$20.81
|
| 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 |
$15.91
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$13.44
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
IP
|
$157.52
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$99.24 |
| Max. Negotiated Rate |
$141.77 |
| Rate for Payer: Aetna Commercial |
$133.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.39
|
| Rate for Payer: Cash Price |
$126.02
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Cofinity Commercial |
$135.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.02
|
| Rate for Payer: Healthscope Commercial |
$141.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.89
|
| Rate for Payer: PHP Commercial |
$133.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.39
|
| Rate for Payer: Priority Health SBD |
$99.24
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
OP
|
$157.52
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$63.01 |
| Max. Negotiated Rate |
$141.77 |
| Rate for Payer: Aetna Commercial |
$133.89
|
| Rate for Payer: Aetna Medicare |
$78.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.39
|
| Rate for Payer: BCBS Complete |
$63.01
|
| Rate for Payer: Cash Price |
$126.02
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Cofinity Commercial |
$135.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.02
|
| Rate for Payer: Healthscope Commercial |
$141.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.89
|
| Rate for Payer: PHP Commercial |
$133.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.39
|
| Rate for Payer: Priority Health SBD |
$99.24
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
IP
|
$1,779.91
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,121.34 |
| Max. Negotiated Rate |
$1,601.92 |
| Rate for Payer: Aetna Commercial |
$1,512.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,156.94
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cofinity Commercial |
$1,245.94
|
| Rate for Payer: Cofinity Commercial |
$1,530.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,245.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,423.93
|
| Rate for Payer: Healthscope Commercial |
$1,601.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,512.92
|
| Rate for Payer: PHP Commercial |
$1,512.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.94
|
| Rate for Payer: Priority Health SBD |
$1,121.34
|
|
