|
HC EXC TUMOR UPPER ARM/ELBOW SUBQ <3CM
|
Facility
|
IP
|
$2,986.24
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
76100310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,239.68 |
| Max. Negotiated Rate |
$2,986.24 |
| Rate for Payer: Aetna Commercial |
$2,687.62
|
| Rate for Payer: ASR ASR |
$2,896.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,452.30
|
| Rate for Payer: BCN Commercial |
$2,452.30
|
| Rate for Payer: Cash Price |
$2,388.99
|
| Rate for Payer: Cofinity Commercial |
$2,807.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,388.99
|
| Rate for Payer: Healthscope Commercial |
$2,896.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,986.24
|
| Rate for Payer: Mclaren Commercial |
$2,687.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,538.30
|
| Rate for Payer: Nomi Health Commercial |
$2,448.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,239.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,627.89
|
|
|
HC EXC TUMOR UPPER ARM/ELBOW SUBQ <3CM
|
Facility
|
OP
|
$2,986.24
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
76100310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$3,014.28 |
| Rate for Payer: Aetna Commercial |
$2,687.62
|
| Rate for Payer: Aetna Medicare |
$1,645.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: ASR ASR |
$2,896.65
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,462.15
|
| Rate for Payer: BCN Commercial |
$2,462.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$2,388.99
|
| Rate for Payer: Cash Price |
$2,388.99
|
| Rate for Payer: Cofinity Commercial |
$2,807.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,388.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$2,896.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,986.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,645.66
|
| Rate for Payer: Mclaren Commercial |
$2,687.62
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$903.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,538.30
|
| Rate for Payer: Nomi Health Commercial |
$2,448.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,239.68
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,810.23
|
| Rate for Payer: PHP Medicaid |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,014.28
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Narrow Network |
$2,411.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,627.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$2,550.77
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP DNSP |
$1,645.66
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC EXERCISE CHALLENGE
|
Facility
|
IP
|
$1,040.64
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
48100108
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$780.48 |
| Max. Negotiated Rate |
$1,040.64 |
| Rate for Payer: Aetna Commercial |
$936.58
|
| Rate for Payer: ASR ASR |
$1,009.42
|
| Rate for Payer: BCBS Trust/PPO |
$854.57
|
| Rate for Payer: BCN Commercial |
$854.57
|
| Rate for Payer: Cash Price |
$832.51
|
| Rate for Payer: Cofinity Commercial |
$978.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.51
|
| Rate for Payer: Healthscope Commercial |
$1,009.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,040.64
|
| Rate for Payer: Mclaren Commercial |
$936.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.54
|
| Rate for Payer: Nomi Health Commercial |
$853.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$915.76
|
|
|
HC EXERCISE CHALLENGE
|
Facility
|
OP
|
$1,040.64
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
48100108
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$385.04 |
| Max. Negotiated Rate |
$1,040.64 |
| Rate for Payer: Aetna Commercial |
$936.58
|
| Rate for Payer: Aetna Medicare |
$385.04
|
| Rate for Payer: ASR ASR |
$1,009.42
|
| Rate for Payer: BCBS Complete |
$416.26
|
| Rate for Payer: BCBS Trust/PPO |
$858.01
|
| Rate for Payer: BCN Commercial |
$858.01
|
| Rate for Payer: Cash Price |
$832.51
|
| Rate for Payer: Cofinity Commercial |
$978.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.51
|
| Rate for Payer: Healthscope Commercial |
$1,009.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,040.64
|
| Rate for Payer: Mclaren Commercial |
$936.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$832.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.54
|
| Rate for Payer: Nomi Health Commercial |
$853.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$911.81
|
| Rate for Payer: Priority Health Narrow Network |
$729.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$915.76
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM W/EKG
|
Facility
|
OP
|
$349.77
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
46000033
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$349.77 |
| Rate for Payer: Aetna Commercial |
$314.79
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$339.28
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$288.39
|
| Rate for Payer: BCN Commercial |
$288.39
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$279.82
|
| Rate for Payer: Cash Price |
$279.82
|
| Rate for Payer: Cofinity Commercial |
$328.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$339.28
|
| Rate for Payer: Healthscope Whirlpool |
$349.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$314.79
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.30
|
| Rate for Payer: Nomi Health Commercial |
$286.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.33
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$132.57
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$106.06
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM W/EKG
|
Facility
|
IP
|
$349.77
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
46000033
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$262.33 |
| Max. Negotiated Rate |
$349.77 |
| Rate for Payer: Aetna Commercial |
$314.79
|
| Rate for Payer: ASR ASR |
$339.28
|
| Rate for Payer: BCBS Trust/PPO |
$287.23
|
| Rate for Payer: BCN Commercial |
$287.23
|
| Rate for Payer: Cash Price |
$279.82
|
| Rate for Payer: Cofinity Commercial |
$328.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.82
|
| Rate for Payer: Healthscope Commercial |
$339.28
|
| Rate for Payer: Healthscope Whirlpool |
$349.77
|
| Rate for Payer: Mclaren Commercial |
$314.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.30
|
| Rate for Payer: Nomi Health Commercial |
$286.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.80
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM WO ECG
|
Facility
|
IP
|
$138.98
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
46000032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$104.23 |
| Max. Negotiated Rate |
$138.98 |
| Rate for Payer: Aetna Commercial |
$125.08
|
| Rate for Payer: ASR ASR |
$134.81
|
| Rate for Payer: BCBS Trust/PPO |
$114.13
|
| Rate for Payer: BCN Commercial |
$114.13
|
| Rate for Payer: Cash Price |
$111.18
|
| Rate for Payer: Cofinity Commercial |
$130.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.18
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Healthscope Whirlpool |
$138.98
|
| Rate for Payer: Mclaren Commercial |
$125.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.13
|
| Rate for Payer: Nomi Health Commercial |
$113.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.30
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM WO ECG
|
Facility
|
OP
|
$138.98
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
46000032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$138.98 |
| Rate for Payer: Aetna Commercial |
$125.08
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$134.81
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$114.59
|
| Rate for Payer: BCN Commercial |
$114.59
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$111.18
|
| Rate for Payer: Cash Price |
$111.18
|
| Rate for Payer: Cofinity Commercial |
$130.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Healthscope Whirlpool |
$138.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$125.08
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.13
|
| Rate for Payer: Nomi Health Commercial |
$113.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.23
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$121.77
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$97.42
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$1,981.19
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,485.89 |
| Max. Negotiated Rate |
$1,981.19 |
| Rate for Payer: Aetna Commercial |
$1,783.07
|
| Rate for Payer: ASR ASR |
$1,921.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,626.95
|
| Rate for Payer: BCN Commercial |
$1,626.95
|
| Rate for Payer: Cash Price |
$1,584.95
|
| Rate for Payer: Cofinity Commercial |
$1,862.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,584.95
|
| Rate for Payer: Healthscope Commercial |
$1,921.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,981.19
|
| Rate for Payer: Mclaren Commercial |
$1,783.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,684.01
|
| Rate for Payer: Nomi Health Commercial |
$1,624.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,485.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,743.45
|
|
|
HC EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$1,981.19
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$2,550.77 |
| Rate for Payer: Aetna Commercial |
$1,783.07
|
| Rate for Payer: Aetna Medicare |
$1,645.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: ASR ASR |
$1,921.75
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,633.49
|
| Rate for Payer: BCN Commercial |
$1,633.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$1,584.95
|
| Rate for Payer: Cash Price |
$1,584.95
|
| Rate for Payer: Cofinity Commercial |
$1,862.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,584.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$1,921.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,981.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,645.66
|
| Rate for Payer: Mclaren Commercial |
$1,783.07
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$903.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,684.01
|
| Rate for Payer: Nomi Health Commercial |
$1,624.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,485.89
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,810.23
|
| Rate for Payer: PHP Medicaid |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,170.54
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,736.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,743.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$2,550.77
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP DNSP |
$1,645.66
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
IP
|
$1,796.14
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,347.11 |
| Max. Negotiated Rate |
$1,796.14 |
| Rate for Payer: Aetna Commercial |
$1,616.53
|
| Rate for Payer: ASR ASR |
$1,742.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.99
|
| Rate for Payer: BCN Commercial |
$1,474.99
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cofinity Commercial |
$1,688.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,436.91
|
| Rate for Payer: Healthscope Commercial |
$1,742.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,796.14
|
| Rate for Payer: Mclaren Commercial |
$1,616.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.72
|
| Rate for Payer: Nomi Health Commercial |
$1,472.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,347.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,580.60
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
OP
|
$1,796.14
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$664.57 |
| Max. Negotiated Rate |
$1,796.14 |
| Rate for Payer: Aetna Commercial |
$1,616.53
|
| Rate for Payer: Aetna Medicare |
$664.57
|
| Rate for Payer: ASR ASR |
$1,742.26
|
| Rate for Payer: BCBS Complete |
$718.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,480.92
|
| Rate for Payer: BCN Commercial |
$1,480.92
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cofinity Commercial |
$1,688.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,436.91
|
| Rate for Payer: Healthscope Commercial |
$1,742.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,796.14
|
| Rate for Payer: Mclaren Commercial |
$1,616.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,436.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.72
|
| Rate for Payer: Nomi Health Commercial |
$1,472.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,347.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,573.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,259.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,580.60
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
OP
|
$2,099.99
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$777.00 |
| Max. Negotiated Rate |
$2,099.99 |
| Rate for Payer: Aetna Commercial |
$1,889.99
|
| Rate for Payer: Aetna Medicare |
$777.00
|
| Rate for Payer: ASR ASR |
$2,036.99
|
| Rate for Payer: BCBS Complete |
$840.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,731.44
|
| Rate for Payer: BCN Commercial |
$1,731.44
|
| Rate for Payer: Cash Price |
$1,679.99
|
| Rate for Payer: Cofinity Commercial |
$1,973.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,679.99
|
| Rate for Payer: Healthscope Commercial |
$2,036.99
|
| Rate for Payer: Healthscope Whirlpool |
$2,099.99
|
| Rate for Payer: Mclaren Commercial |
$1,889.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,679.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,784.99
|
| Rate for Payer: Nomi Health Commercial |
$1,721.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,574.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,840.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,472.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,847.99
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
IP
|
$2,099.99
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,574.99 |
| Max. Negotiated Rate |
$2,099.99 |
| Rate for Payer: Aetna Commercial |
$1,889.99
|
| Rate for Payer: ASR ASR |
$2,036.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,724.51
|
| Rate for Payer: BCN Commercial |
$1,724.51
|
| Rate for Payer: Cash Price |
$1,679.99
|
| Rate for Payer: Cofinity Commercial |
$1,973.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,679.99
|
| Rate for Payer: Healthscope Commercial |
$2,036.99
|
| Rate for Payer: Healthscope Whirlpool |
$2,099.99
|
| Rate for Payer: Mclaren Commercial |
$1,889.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,784.99
|
| Rate for Payer: Nomi Health Commercial |
$1,721.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,574.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,847.99
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
OP
|
$2,295.29
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$849.26 |
| Max. Negotiated Rate |
$2,295.29 |
| Rate for Payer: Aetna Commercial |
$2,065.76
|
| Rate for Payer: Aetna Medicare |
$849.26
|
| Rate for Payer: ASR ASR |
$2,226.43
|
| Rate for Payer: BCBS Complete |
$918.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,892.47
|
| Rate for Payer: BCN Commercial |
$1,892.47
|
| Rate for Payer: Cash Price |
$1,836.23
|
| Rate for Payer: Cofinity Commercial |
$2,157.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,836.23
|
| Rate for Payer: Healthscope Commercial |
$2,226.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,295.29
|
| Rate for Payer: Mclaren Commercial |
$2,065.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,836.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,951.00
|
| Rate for Payer: Nomi Health Commercial |
$1,882.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,721.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,011.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,609.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,019.86
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
IP
|
$2,295.29
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,721.47 |
| Max. Negotiated Rate |
$2,295.29 |
| Rate for Payer: Aetna Commercial |
$2,065.76
|
| Rate for Payer: ASR ASR |
$2,226.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,884.89
|
| Rate for Payer: BCN Commercial |
$1,884.89
|
| Rate for Payer: Cash Price |
$1,836.23
|
| Rate for Payer: Cofinity Commercial |
$2,157.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,836.23
|
| Rate for Payer: Healthscope Commercial |
$2,226.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,295.29
|
| Rate for Payer: Mclaren Commercial |
$2,065.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,951.00
|
| Rate for Payer: Nomi Health Commercial |
$1,882.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,721.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,019.86
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
OP
|
$1,964.32
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$726.80 |
| Max. Negotiated Rate |
$1,964.32 |
| Rate for Payer: Aetna Commercial |
$1,767.89
|
| Rate for Payer: Aetna Medicare |
$726.80
|
| Rate for Payer: ASR ASR |
$1,905.39
|
| Rate for Payer: BCBS Complete |
$785.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,619.58
|
| Rate for Payer: BCN Commercial |
$1,619.58
|
| Rate for Payer: Cash Price |
$1,571.46
|
| Rate for Payer: Cofinity Commercial |
$1,846.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.46
|
| Rate for Payer: Healthscope Commercial |
$1,905.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,964.32
|
| Rate for Payer: Mclaren Commercial |
$1,767.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,571.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.67
|
| Rate for Payer: Nomi Health Commercial |
$1,610.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,721.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,376.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,728.60
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
IP
|
$1,964.32
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,473.24 |
| Max. Negotiated Rate |
$1,964.32 |
| Rate for Payer: Aetna Commercial |
$1,767.89
|
| Rate for Payer: ASR ASR |
$1,905.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,613.10
|
| Rate for Payer: BCN Commercial |
$1,613.10
|
| Rate for Payer: Cash Price |
$1,571.46
|
| Rate for Payer: Cofinity Commercial |
$1,846.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.46
|
| Rate for Payer: Healthscope Commercial |
$1,905.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,964.32
|
| Rate for Payer: Mclaren Commercial |
$1,767.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.67
|
| Rate for Payer: Nomi Health Commercial |
$1,610.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,728.60
|
|
|
HC EXTENDED RECOVERY PER HR
|
Facility
|
OP
|
$145.86
|
|
| Hospital Charge Code |
71000038
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$145.86 |
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: Aetna Medicare |
$53.97
|
| Rate for Payer: ASR ASR |
$141.48
|
| Rate for Payer: BCBS Complete |
$58.34
|
| Rate for Payer: BCBS Trust/PPO |
$120.26
|
| Rate for Payer: BCN Commercial |
$120.26
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Commercial |
$137.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.69
|
| Rate for Payer: Healthscope Commercial |
$141.48
|
| Rate for Payer: Healthscope Whirlpool |
$145.86
|
| Rate for Payer: Mclaren Commercial |
$131.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.98
|
| Rate for Payer: Nomi Health Commercial |
$119.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$127.80
|
| Rate for Payer: Priority Health Narrow Network |
$102.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.36
|
|
|
HC EXTENDED RECOVERY PER HR
|
Facility
|
IP
|
$145.86
|
|
| Hospital Charge Code |
71000038
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$109.39 |
| Max. Negotiated Rate |
$145.86 |
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: ASR ASR |
$141.48
|
| Rate for Payer: BCBS Trust/PPO |
$119.78
|
| Rate for Payer: BCN Commercial |
$119.78
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Commercial |
$137.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.69
|
| Rate for Payer: Healthscope Commercial |
$141.48
|
| Rate for Payer: Healthscope Whirlpool |
$145.86
|
| Rate for Payer: Mclaren Commercial |
$131.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.98
|
| Rate for Payer: Nomi Health Commercial |
$119.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.36
|
|
|
HC EXTENSION KIT
|
Facility
|
IP
|
$2,072.62
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,554.46 |
| Max. Negotiated Rate |
$2,072.62 |
| Rate for Payer: Aetna Commercial |
$1,865.36
|
| Rate for Payer: ASR ASR |
$2,010.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,702.04
|
| Rate for Payer: BCN Commercial |
$1,702.04
|
| Rate for Payer: Cash Price |
$1,658.10
|
| Rate for Payer: Cofinity Commercial |
$1,948.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.10
|
| Rate for Payer: Healthscope Commercial |
$2,010.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,072.62
|
| Rate for Payer: Mclaren Commercial |
$1,865.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.73
|
| Rate for Payer: Nomi Health Commercial |
$1,699.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,554.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,823.91
|
|
|
HC EXTENSION KIT
|
Facility
|
OP
|
$2,072.62
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$766.87 |
| Max. Negotiated Rate |
$2,072.62 |
| Rate for Payer: Aetna Commercial |
$1,865.36
|
| Rate for Payer: Aetna Medicare |
$766.87
|
| Rate for Payer: ASR ASR |
$2,010.44
|
| Rate for Payer: BCBS Complete |
$829.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.88
|
| Rate for Payer: BCN Commercial |
$1,708.88
|
| Rate for Payer: Cash Price |
$1,658.10
|
| Rate for Payer: Cofinity Commercial |
$1,948.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.10
|
| Rate for Payer: Healthscope Commercial |
$2,010.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,072.62
|
| Rate for Payer: Mclaren Commercial |
$1,865.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,658.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.73
|
| Rate for Payer: Nomi Health Commercial |
$1,699.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,554.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,816.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,452.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,823.91
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
OP
|
$2,418.07
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.69 |
| Max. Negotiated Rate |
$2,418.07 |
| Rate for Payer: Aetna Commercial |
$2,176.26
|
| Rate for Payer: Aetna Medicare |
$894.69
|
| Rate for Payer: ASR ASR |
$2,345.53
|
| Rate for Payer: BCBS Complete |
$967.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,993.70
|
| Rate for Payer: BCN Commercial |
$1,993.70
|
| Rate for Payer: Cash Price |
$1,934.46
|
| Rate for Payer: Cofinity Commercial |
$2,272.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.46
|
| Rate for Payer: Healthscope Commercial |
$2,345.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,418.07
|
| Rate for Payer: Mclaren Commercial |
$2,176.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,055.36
|
| Rate for Payer: Nomi Health Commercial |
$1,982.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,813.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,118.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,695.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,127.90
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
IP
|
$2,418.07
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,813.55 |
| Max. Negotiated Rate |
$2,418.07 |
| Rate for Payer: Aetna Commercial |
$2,176.26
|
| Rate for Payer: ASR ASR |
$2,345.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,985.72
|
| Rate for Payer: BCN Commercial |
$1,985.72
|
| Rate for Payer: Cash Price |
$1,934.46
|
| Rate for Payer: Cofinity Commercial |
$2,272.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.46
|
| Rate for Payer: Healthscope Commercial |
$2,345.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,418.07
|
| Rate for Payer: Mclaren Commercial |
$2,176.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,055.36
|
| Rate for Payer: Nomi Health Commercial |
$1,982.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,813.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,127.90
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
OP
|
$92.95
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$92.95 |
| Rate for Payer: Aetna Commercial |
$83.66
|
| Rate for Payer: Aetna Medicare |
$37.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: ASR ASR |
$90.16
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$76.64
|
| Rate for Payer: BCN Commercial |
$76.64
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Cofinity Commercial |
$87.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$90.16
|
| Rate for Payer: Healthscope Whirlpool |
$92.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.22
|
| Rate for Payer: Mclaren Commercial |
$83.66
|
| Rate for Payer: Mclaren Medicaid |
$37.22
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$20.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.01
|
| Rate for Payer: Nomi Health Commercial |
$76.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.71
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$40.94
|
| Rate for Payer: PHP Medicaid |
$19.95
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$81.44
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health Narrow Network |
$65.16
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$57.69
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP DNSP |
$37.22
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
