|
HC INTRA AORTIC BALLOON REMOVAL PERCUTANEOUS
|
Facility
|
IP
|
$1,313.96
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
48100104
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$827.79 |
| Max. Negotiated Rate |
$1,182.56 |
| Rate for Payer: Aetna Commercial |
$1,116.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.07
|
| Rate for Payer: Cash Price |
$1,051.17
|
| Rate for Payer: Cofinity Commercial |
$1,130.01
|
| Rate for Payer: Cofinity Commercial |
$919.77
|
| Rate for Payer: Healthscope Commercial |
$1,182.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,116.87
|
| Rate for Payer: PHP Commercial |
$1,116.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.77
|
| Rate for Payer: Priority Health SBD |
$827.79
|
|
|
HC INTRA AORTIC BALLOON REMOVAL PERCUTANEOUS
|
Facility
|
OP
|
$1,313.96
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
48100104
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$11,194.00 |
| Rate for Payer: Aetna Commercial |
$1,116.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.07
|
| Rate for Payer: BCBS Complete |
$525.58
|
| Rate for Payer: BCBS Trust/PPO |
$69.01
|
| Rate for Payer: Cash Price |
$1,051.17
|
| Rate for Payer: Cash Price |
$1,051.17
|
| Rate for Payer: Cofinity Commercial |
$919.77
|
| Rate for Payer: Cofinity Commercial |
$1,130.01
|
| Rate for Payer: Healthscope Commercial |
$1,182.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,116.87
|
| Rate for Payer: PHP Commercial |
$1,116.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.77
|
| Rate for Payer: Priority Health SBD |
$827.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.66
|
| Rate for Payer: UHC Core |
$11,194.00
|
| Rate for Payer: UHC Exchange |
$32.42
|
|
|
HC INTRA ART ADMIN RP PARTICULATE
|
Facility
|
IP
|
$1,052.08
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
34200001
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$662.81 |
| Max. Negotiated Rate |
$946.87 |
| Rate for Payer: Aetna Commercial |
$894.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.85
|
| Rate for Payer: Cash Price |
$841.66
|
| Rate for Payer: Cofinity Commercial |
$736.46
|
| Rate for Payer: Cofinity Commercial |
$904.79
|
| Rate for Payer: Healthscope Commercial |
$946.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$894.27
|
| Rate for Payer: PHP Commercial |
$894.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.46
|
| Rate for Payer: Priority Health SBD |
$662.81
|
|
|
HC INTRA ART ADMIN RP PARTICULATE
|
Facility
|
OP
|
$1,052.08
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
34200001
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$121.09 |
| Max. Negotiated Rate |
$946.87 |
| Rate for Payer: Aetna Commercial |
$894.27
|
| Rate for Payer: Aetna Medicare |
$230.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.71
|
| Rate for Payer: BCBS Complete |
$127.15
|
| Rate for Payer: BCBS MAPPO |
$221.37
|
| Rate for Payer: BCBS Trust/PPO |
$260.74
|
| Rate for Payer: BCN Medicare Advantage |
$221.37
|
| Rate for Payer: Cash Price |
$841.66
|
| Rate for Payer: Cash Price |
$841.66
|
| Rate for Payer: Cofinity Commercial |
$904.79
|
| Rate for Payer: Cofinity Commercial |
$736.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.37
|
| Rate for Payer: Healthscope Commercial |
$946.87
|
| Rate for Payer: Mclaren Medicaid |
$121.09
|
| Rate for Payer: Mclaren Medicare |
$221.37
|
| Rate for Payer: Meridian Medicaid |
$127.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$894.27
|
| Rate for Payer: PACE Medicare |
$210.30
|
| Rate for Payer: PACE SWMI |
$221.37
|
| Rate for Payer: PHP Commercial |
$894.27
|
| Rate for Payer: PHP Medicare Advantage |
$221.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$787.85
|
| Rate for Payer: Priority Health Medicare |
$221.37
|
| Rate for Payer: Priority Health Narrow Network |
$630.28
|
| Rate for Payer: Priority Health SBD |
$662.81
|
| Rate for Payer: Railroad Medicare Medicare |
$221.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.37
|
| Rate for Payer: UHC Medicare Advantage |
$228.01
|
| Rate for Payer: VA VA |
$221.37
|
|
|
HC INTRA ATRIAL PACING
|
Facility
|
OP
|
$3,086.75
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
48100033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,944.65 |
| Max. Negotiated Rate |
$19,563.35 |
| Rate for Payer: Aetna Commercial |
$2,623.74
|
| Rate for Payer: Aetna Medicare |
$6,910.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,006.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,306.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,306.42
|
| Rate for Payer: BCBS Complete |
$3,816.97
|
| Rate for Payer: BCBS MAPPO |
$6,645.14
|
| Rate for Payer: BCBS Trust/PPO |
$19,563.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,645.14
|
| Rate for Payer: Cash Price |
$2,469.40
|
| Rate for Payer: Cash Price |
$2,469.40
|
| Rate for Payer: Cofinity Commercial |
$2,654.60
|
| Rate for Payer: Cofinity Commercial |
$2,160.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,645.14
|
| Rate for Payer: Healthscope Commercial |
$2,778.08
|
| Rate for Payer: Mclaren Medicaid |
$3,634.89
|
| Rate for Payer: Mclaren Medicare |
$6,645.14
|
| Rate for Payer: Meridian Medicaid |
$3,816.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,977.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,641.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,623.74
|
| Rate for Payer: PACE Medicare |
$6,312.88
|
| Rate for Payer: PACE SWMI |
$6,645.14
|
| Rate for Payer: PHP Commercial |
$2,623.74
|
| Rate for Payer: PHP Medicare Advantage |
$6,645.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,634.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,160.72
|
| Rate for Payer: Priority Health Medicare |
$6,645.14
|
| Rate for Payer: Priority Health SBD |
$1,944.65
|
| Rate for Payer: Railroad Medicare Medicare |
$6,645.14
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,645.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,844.49
|
| Rate for Payer: VA VA |
$6,645.14
|
|
|
HC INTRA ATRIAL PACING
|
Facility
|
IP
|
$3,086.75
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
48100033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,944.65 |
| Max. Negotiated Rate |
$2,778.08 |
| Rate for Payer: Aetna Commercial |
$2,623.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,006.39
|
| Rate for Payer: Cash Price |
$2,469.40
|
| Rate for Payer: Cofinity Commercial |
$2,160.72
|
| Rate for Payer: Cofinity Commercial |
$2,654.60
|
| Rate for Payer: Healthscope Commercial |
$2,778.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,623.74
|
| Rate for Payer: PHP Commercial |
$2,623.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,160.72
|
| Rate for Payer: Priority Health SBD |
$1,944.65
|
|
|
HC INTRA ATRIAL RECORDING
|
Facility
|
IP
|
$2,978.40
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
48100030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,876.39 |
| Max. Negotiated Rate |
$2,680.56 |
| Rate for Payer: Aetna Commercial |
$2,531.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,935.96
|
| Rate for Payer: Cash Price |
$2,382.72
|
| Rate for Payer: Cofinity Commercial |
$2,084.88
|
| Rate for Payer: Cofinity Commercial |
$2,561.42
|
| Rate for Payer: Healthscope Commercial |
$2,680.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,531.64
|
| Rate for Payer: PHP Commercial |
$2,531.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,084.88
|
| Rate for Payer: Priority Health SBD |
$1,876.39
|
|
|
HC INTRA ATRIAL RECORDING
|
Facility
|
OP
|
$2,978.40
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
48100030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,876.39 |
| Max. Negotiated Rate |
$19,563.35 |
| Rate for Payer: Aetna Commercial |
$2,531.64
|
| Rate for Payer: Aetna Medicare |
$6,910.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,935.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,306.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,306.42
|
| Rate for Payer: BCBS Complete |
$3,816.97
|
| Rate for Payer: BCBS MAPPO |
$6,645.14
|
| Rate for Payer: BCBS Trust/PPO |
$19,563.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,645.14
|
| Rate for Payer: Cash Price |
$2,382.72
|
| Rate for Payer: Cash Price |
$2,382.72
|
| Rate for Payer: Cofinity Commercial |
$2,561.42
|
| Rate for Payer: Cofinity Commercial |
$2,084.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,645.14
|
| Rate for Payer: Healthscope Commercial |
$2,680.56
|
| Rate for Payer: Mclaren Medicaid |
$3,634.89
|
| Rate for Payer: Mclaren Medicare |
$6,645.14
|
| Rate for Payer: Meridian Medicaid |
$3,816.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,977.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,641.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,531.64
|
| Rate for Payer: PACE Medicare |
$6,312.88
|
| Rate for Payer: PACE SWMI |
$6,645.14
|
| Rate for Payer: PHP Commercial |
$2,531.64
|
| Rate for Payer: PHP Medicare Advantage |
$6,645.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,634.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,084.88
|
| Rate for Payer: Priority Health Medicare |
$6,645.14
|
| Rate for Payer: Priority Health SBD |
$1,876.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6,645.14
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,645.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,844.49
|
| Rate for Payer: VA VA |
$6,645.14
|
|
|
HC INTRACARDIAC ECHOCARDIOGRAPHY
|
Facility
|
OP
|
$5,403.31
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
48100047
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$331.57 |
| Max. Negotiated Rate |
$4,862.98 |
| Rate for Payer: Aetna Commercial |
$4,592.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,512.15
|
| Rate for Payer: BCBS Complete |
$2,161.32
|
| Rate for Payer: BCBS Trust/PPO |
$331.57
|
| Rate for Payer: Cash Price |
$4,322.65
|
| Rate for Payer: Cash Price |
$4,322.65
|
| Rate for Payer: Cofinity Commercial |
$4,646.85
|
| Rate for Payer: Cofinity Commercial |
$3,782.32
|
| Rate for Payer: Healthscope Commercial |
$4,862.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,592.81
|
| Rate for Payer: PHP Commercial |
$4,592.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,782.32
|
| Rate for Payer: Priority Health SBD |
$3,404.09
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC INTRACARDIAC ECHOCARDIOGRAPHY
|
Facility
|
IP
|
$5,403.31
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
48100047
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,404.09 |
| Max. Negotiated Rate |
$4,862.98 |
| Rate for Payer: Aetna Commercial |
$4,592.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,512.15
|
| Rate for Payer: Cash Price |
$4,322.65
|
| Rate for Payer: Cofinity Commercial |
$3,782.32
|
| Rate for Payer: Cofinity Commercial |
$4,646.85
|
| Rate for Payer: Healthscope Commercial |
$4,862.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,592.81
|
| Rate for Payer: PHP Commercial |
$4,592.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,782.32
|
| Rate for Payer: Priority Health SBD |
$3,404.09
|
|
|
HC INTRACAV APPL - I
|
Facility
|
OP
|
$801.00
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$286.51 |
| Max. Negotiated Rate |
$720.90 |
| Rate for Payer: Aetna Commercial |
$680.85
|
| Rate for Payer: Aetna Commercial |
$477.72
|
| Rate for Payer: Aetna Medicare |
$544.74
|
| Rate for Payer: Aetna Medicare |
$544.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.74
|
| Rate for Payer: BCBS Complete |
$300.86
|
| Rate for Payer: BCBS Complete |
$300.86
|
| Rate for Payer: BCBS MAPPO |
$523.79
|
| Rate for Payer: BCBS MAPPO |
$523.79
|
| Rate for Payer: BCBS Trust/PPO |
$408.73
|
| Rate for Payer: BCBS Trust/PPO |
$408.73
|
| Rate for Payer: BCN Medicare Advantage |
$523.79
|
| Rate for Payer: BCN Medicare Advantage |
$523.79
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$449.62
|
| Rate for Payer: Cash Price |
$449.62
|
| Rate for Payer: Cofinity Commercial |
$688.86
|
| Rate for Payer: Cofinity Commercial |
$393.41
|
| Rate for Payer: Cofinity Commercial |
$483.34
|
| Rate for Payer: Cofinity Commercial |
$560.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.79
|
| Rate for Payer: Healthscope Commercial |
$505.82
|
| Rate for Payer: Healthscope Commercial |
$720.90
|
| Rate for Payer: Mclaren Medicaid |
$286.51
|
| Rate for Payer: Mclaren Medicaid |
$286.51
|
| Rate for Payer: Mclaren Medicare |
$523.79
|
| Rate for Payer: Mclaren Medicare |
$523.79
|
| Rate for Payer: Meridian Medicaid |
$300.86
|
| Rate for Payer: Meridian Medicaid |
$300.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$477.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.85
|
| Rate for Payer: PACE Medicare |
$497.60
|
| Rate for Payer: PACE Medicare |
$497.60
|
| Rate for Payer: PACE SWMI |
$523.79
|
| Rate for Payer: PACE SWMI |
$523.79
|
| Rate for Payer: PHP Commercial |
$680.85
|
| Rate for Payer: PHP Commercial |
$477.72
|
| Rate for Payer: PHP Medicare Advantage |
$523.79
|
| Rate for Payer: PHP Medicare Advantage |
$523.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.41
|
| Rate for Payer: Priority Health Medicare |
$523.79
|
| Rate for Payer: Priority Health Medicare |
$523.79
|
| Rate for Payer: Priority Health SBD |
$354.07
|
| Rate for Payer: Priority Health SBD |
$504.63
|
| Rate for Payer: Railroad Medicare Medicare |
$523.79
|
| Rate for Payer: Railroad Medicare Medicare |
$523.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$523.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$523.79
|
| Rate for Payer: UHC Exchange |
$544.21
|
| Rate for Payer: UHC Exchange |
$544.21
|
| Rate for Payer: UHC Medicare Advantage |
$539.50
|
| Rate for Payer: UHC Medicare Advantage |
$539.50
|
| Rate for Payer: VA VA |
$523.79
|
| Rate for Payer: VA VA |
$523.79
|
|
|
HC INTRACAV APPL - I
|
Facility
|
IP
|
$801.00
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$504.63 |
| Max. Negotiated Rate |
$720.90 |
| Rate for Payer: Aetna Commercial |
$680.85
|
| Rate for Payer: Aetna Commercial |
$477.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.65
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$449.62
|
| Rate for Payer: Cofinity Commercial |
$483.34
|
| Rate for Payer: Cofinity Commercial |
$688.86
|
| Rate for Payer: Cofinity Commercial |
$560.70
|
| Rate for Payer: Cofinity Commercial |
$393.41
|
| Rate for Payer: Healthscope Commercial |
$720.90
|
| Rate for Payer: Healthscope Commercial |
$505.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$477.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.85
|
| Rate for Payer: PHP Commercial |
$477.72
|
| Rate for Payer: PHP Commercial |
$680.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.41
|
| Rate for Payer: Priority Health SBD |
$504.63
|
| Rate for Payer: Priority Health SBD |
$354.07
|
|
|
HC INTRACAV APPL - S
|
Facility
|
OP
|
$428.40
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
33300027
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$269.89 |
| Max. Negotiated Rate |
$654.74 |
| Rate for Payer: Aetna Commercial |
$364.14
|
| Rate for Payer: Aetna Commercial |
$514.25
|
| Rate for Payer: Aetna Medicare |
$544.74
|
| Rate for Payer: Aetna Medicare |
$544.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.74
|
| Rate for Payer: BCBS Complete |
$300.86
|
| Rate for Payer: BCBS Complete |
$300.86
|
| Rate for Payer: BCBS MAPPO |
$523.79
|
| Rate for Payer: BCBS MAPPO |
$523.79
|
| Rate for Payer: BCBS Trust/PPO |
$356.33
|
| Rate for Payer: BCBS Trust/PPO |
$356.33
|
| Rate for Payer: BCN Medicare Advantage |
$523.79
|
| Rate for Payer: BCN Medicare Advantage |
$523.79
|
| Rate for Payer: Cash Price |
$342.72
|
| Rate for Payer: Cash Price |
$342.72
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$520.30
|
| Rate for Payer: Cofinity Commercial |
$423.50
|
| Rate for Payer: Cofinity Commercial |
$368.42
|
| Rate for Payer: Cofinity Commercial |
$299.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.79
|
| Rate for Payer: Healthscope Commercial |
$544.50
|
| Rate for Payer: Healthscope Commercial |
$385.56
|
| Rate for Payer: Mclaren Medicaid |
$286.51
|
| Rate for Payer: Mclaren Medicaid |
$286.51
|
| Rate for Payer: Mclaren Medicare |
$523.79
|
| Rate for Payer: Mclaren Medicare |
$523.79
|
| Rate for Payer: Meridian Medicaid |
$300.86
|
| Rate for Payer: Meridian Medicaid |
$300.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.25
|
| Rate for Payer: PACE Medicare |
$497.60
|
| Rate for Payer: PACE Medicare |
$497.60
|
| Rate for Payer: PACE SWMI |
$523.79
|
| Rate for Payer: PACE SWMI |
$523.79
|
| Rate for Payer: PHP Commercial |
$364.14
|
| Rate for Payer: PHP Commercial |
$514.25
|
| Rate for Payer: PHP Medicare Advantage |
$523.79
|
| Rate for Payer: PHP Medicare Advantage |
$523.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.50
|
| Rate for Payer: Priority Health Medicare |
$523.79
|
| Rate for Payer: Priority Health Medicare |
$523.79
|
| Rate for Payer: Priority Health SBD |
$381.15
|
| Rate for Payer: Priority Health SBD |
$269.89
|
| Rate for Payer: Railroad Medicare Medicare |
$523.79
|
| Rate for Payer: Railroad Medicare Medicare |
$523.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$523.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$523.79
|
| Rate for Payer: UHC Exchange |
$414.21
|
| Rate for Payer: UHC Exchange |
$414.21
|
| Rate for Payer: UHC Medicare Advantage |
$539.50
|
| Rate for Payer: UHC Medicare Advantage |
$539.50
|
| Rate for Payer: VA VA |
$523.79
|
| Rate for Payer: VA VA |
$523.79
|
|
|
HC INTRACAV APPL - S
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
33300027
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$381.15 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Aetna Commercial |
$514.25
|
| Rate for Payer: Aetna Commercial |
$364.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.25
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$342.72
|
| Rate for Payer: Cofinity Commercial |
$423.50
|
| Rate for Payer: Cofinity Commercial |
$299.88
|
| Rate for Payer: Cofinity Commercial |
$368.42
|
| Rate for Payer: Cofinity Commercial |
$520.30
|
| Rate for Payer: Healthscope Commercial |
$385.56
|
| Rate for Payer: Healthscope Commercial |
$544.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.25
|
| Rate for Payer: PHP Commercial |
$514.25
|
| Rate for Payer: PHP Commercial |
$364.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.50
|
| Rate for Payer: Priority Health SBD |
$381.15
|
| Rate for Payer: Priority Health SBD |
$269.89
|
|
|
HC INTRAOCULAR LENS
|
Facility
|
IP
|
$648.37
|
|
| Hospital Charge Code |
27600003
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$408.47 |
| Max. Negotiated Rate |
$583.53 |
| Rate for Payer: Aetna Commercial |
$551.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.44
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: Cofinity Commercial |
$453.86
|
| Rate for Payer: Cofinity Commercial |
$557.60
|
| Rate for Payer: Healthscope Commercial |
$583.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$551.11
|
| Rate for Payer: PHP Commercial |
$551.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.86
|
| Rate for Payer: Priority Health SBD |
$408.47
|
|
|
HC INTRAOCULAR LENS
|
Facility
|
OP
|
$648.37
|
|
| Hospital Charge Code |
27600003
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$259.35 |
| Max. Negotiated Rate |
$583.53 |
| Rate for Payer: Aetna Commercial |
$551.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.44
|
| Rate for Payer: BCBS Complete |
$259.35
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: Cofinity Commercial |
$453.86
|
| Rate for Payer: Cofinity Commercial |
$557.60
|
| Rate for Payer: Healthscope Commercial |
$583.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$551.11
|
| Rate for Payer: PHP Commercial |
$551.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.86
|
| Rate for Payer: Priority Health SBD |
$408.47
|
|
|
HC INTRAOSSEOUS NEEDLE PLACEMENT
|
Facility
|
OP
|
$475.38
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$1,132.15 |
| Rate for Payer: Aetna Commercial |
$404.07
|
| Rate for Payer: Aetna Medicare |
$368.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.16
|
| Rate for Payer: BCBS Complete |
$203.64
|
| Rate for Payer: BCBS MAPPO |
$354.53
|
| Rate for Payer: BCBS Trust/PPO |
$137.23
|
| Rate for Payer: BCN Medicare Advantage |
$354.53
|
| Rate for Payer: Cash Price |
$380.30
|
| Rate for Payer: Cash Price |
$380.30
|
| Rate for Payer: Cofinity Commercial |
$408.83
|
| Rate for Payer: Cofinity Commercial |
$332.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.53
|
| Rate for Payer: Healthscope Commercial |
$427.84
|
| Rate for Payer: Mclaren Medicaid |
$193.93
|
| Rate for Payer: Mclaren Medicare |
$354.53
|
| Rate for Payer: Meridian Medicaid |
$203.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.07
|
| Rate for Payer: PACE Medicare |
$336.80
|
| Rate for Payer: PACE SWMI |
$354.53
|
| Rate for Payer: PHP Commercial |
$404.07
|
| Rate for Payer: PHP Medicare Advantage |
$354.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,132.15
|
| Rate for Payer: Priority Health Medicare |
$354.53
|
| Rate for Payer: Priority Health Narrow Network |
$905.72
|
| Rate for Payer: Priority Health SBD |
$299.49
|
| Rate for Payer: Railroad Medicare Medicare |
$354.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.53
|
| Rate for Payer: UHC Exchange |
$57.96
|
| Rate for Payer: UHC Medicare Advantage |
$365.17
|
| Rate for Payer: VA VA |
$354.53
|
|
|
HC INTRAOSSEOUS NEEDLE PLACEMENT
|
Facility
|
IP
|
$475.38
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.49 |
| Max. Negotiated Rate |
$427.84 |
| Rate for Payer: Aetna Commercial |
$404.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.00
|
| Rate for Payer: Cash Price |
$380.30
|
| Rate for Payer: Cofinity Commercial |
$332.77
|
| Rate for Payer: Cofinity Commercial |
$408.83
|
| Rate for Payer: Healthscope Commercial |
$427.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.07
|
| Rate for Payer: PHP Commercial |
$404.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.77
|
| Rate for Payer: Priority Health SBD |
$299.49
|
|
|
HC INTRASPINAL CATHETER
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
27200248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Aetna Commercial |
$243.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.55
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$200.90
|
| Rate for Payer: Cofinity Commercial |
$246.82
|
| Rate for Payer: Healthscope Commercial |
$258.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.95
|
| Rate for Payer: PHP Commercial |
$243.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.90
|
| Rate for Payer: Priority Health SBD |
$180.81
|
|
|
HC INTRASPINAL CATHETER
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
27200248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Aetna Commercial |
$243.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.55
|
| Rate for Payer: BCBS Complete |
$114.80
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$200.90
|
| Rate for Payer: Cofinity Commercial |
$246.82
|
| Rate for Payer: Healthscope Commercial |
$258.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.95
|
| Rate for Payer: PHP Commercial |
$243.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.90
|
| Rate for Payer: Priority Health SBD |
$180.81
|
|
|
HC INTRAUTERINE COPPER CONTRACEPTIVE
|
Facility
|
IP
|
$1,730.82
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
63600119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,090.42 |
| Max. Negotiated Rate |
$1,557.74 |
| Rate for Payer: Aetna Commercial |
$1,471.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,125.03
|
| Rate for Payer: Cash Price |
$1,384.66
|
| Rate for Payer: Cofinity Commercial |
$1,211.57
|
| Rate for Payer: Cofinity Commercial |
$1,488.51
|
| Rate for Payer: Healthscope Commercial |
$1,557.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,471.20
|
| Rate for Payer: PHP Commercial |
$1,471.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,211.57
|
| Rate for Payer: Priority Health SBD |
$1,090.42
|
|
|
HC INTRAUTERINE COPPER CONTRACEPTIVE
|
Facility
|
OP
|
$1,730.82
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
63600119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$692.33 |
| Max. Negotiated Rate |
$3,196.82 |
| Rate for Payer: Aetna Commercial |
$1,471.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,125.03
|
| Rate for Payer: BCBS Complete |
$692.33
|
| Rate for Payer: BCBS Trust/PPO |
$3,196.82
|
| Rate for Payer: Cash Price |
$1,384.66
|
| Rate for Payer: Cash Price |
$1,384.66
|
| Rate for Payer: Cofinity Commercial |
$1,488.51
|
| Rate for Payer: Cofinity Commercial |
$1,211.57
|
| Rate for Payer: Healthscope Commercial |
$1,557.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,471.20
|
| Rate for Payer: PHP Commercial |
$1,471.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,211.57
|
| Rate for Payer: Priority Health SBD |
$1,090.42
|
|
|
HC INTRAVENTRICULAR PACING
|
Facility
|
IP
|
$3,693.37
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
48100034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,326.82 |
| Max. Negotiated Rate |
$3,324.03 |
| Rate for Payer: Aetna Commercial |
$3,139.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.69
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cofinity Commercial |
$2,585.36
|
| Rate for Payer: Cofinity Commercial |
$3,176.30
|
| Rate for Payer: Healthscope Commercial |
$3,324.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.36
|
| Rate for Payer: PHP Commercial |
$3,139.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.36
|
| Rate for Payer: Priority Health SBD |
$2,326.82
|
|
|
HC INTRAVENTRICULAR PACING
|
Facility
|
OP
|
$3,693.37
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
48100034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,326.82 |
| Max. Negotiated Rate |
$19,563.35 |
| Rate for Payer: Aetna Commercial |
$3,139.36
|
| Rate for Payer: Aetna Medicare |
$6,910.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,306.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,306.42
|
| Rate for Payer: BCBS Complete |
$3,816.97
|
| Rate for Payer: BCBS MAPPO |
$6,645.14
|
| Rate for Payer: BCBS Trust/PPO |
$19,563.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,645.14
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cofinity Commercial |
$3,176.30
|
| Rate for Payer: Cofinity Commercial |
$2,585.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,645.14
|
| Rate for Payer: Healthscope Commercial |
$3,324.03
|
| Rate for Payer: Mclaren Medicaid |
$3,634.89
|
| Rate for Payer: Mclaren Medicare |
$6,645.14
|
| Rate for Payer: Meridian Medicaid |
$3,816.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,977.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,641.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.36
|
| Rate for Payer: PACE Medicare |
$6,312.88
|
| Rate for Payer: PACE SWMI |
$6,645.14
|
| Rate for Payer: PHP Commercial |
$3,139.36
|
| Rate for Payer: PHP Medicare Advantage |
$6,645.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,634.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.36
|
| Rate for Payer: Priority Health Medicare |
$6,645.14
|
| Rate for Payer: Priority Health SBD |
$2,326.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,645.14
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,645.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,844.49
|
| Rate for Payer: VA VA |
$6,645.14
|
|
|
HC INTRINSIC FACTOR ANTIBODIES
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
30200200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$40.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PHP Commercial |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$30.24
|
|
