|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
IP
|
$12,115.61
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,632.83 |
| Max. Negotiated Rate |
$10,904.05 |
| Rate for Payer: Aetna Commercial |
$10,298.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,875.15
|
| Rate for Payer: Cash Price |
$9,692.49
|
| Rate for Payer: Cofinity Commercial |
$8,480.93
|
| Rate for Payer: Cofinity Commercial |
$10,419.42
|
| Rate for Payer: Healthscope Commercial |
$10,904.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,298.27
|
| Rate for Payer: PHP Commercial |
$10,298.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,480.93
|
| Rate for Payer: Priority Health SBD |
$7,632.83
|
|
|
HC LUMASON PER ML
|
Facility
|
IP
|
$77.94
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.10 |
| Max. Negotiated Rate |
$70.15 |
| Rate for Payer: Aetna Commercial |
$66.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.66
|
| Rate for Payer: Cash Price |
$62.35
|
| Rate for Payer: Cofinity Commercial |
$54.56
|
| Rate for Payer: Cofinity Commercial |
$67.03
|
| Rate for Payer: Healthscope Commercial |
$70.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.25
|
| Rate for Payer: PHP Commercial |
$66.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.56
|
| Rate for Payer: Priority Health SBD |
$49.10
|
|
|
HC LUMASON PER ML
|
Facility
|
OP
|
$77.94
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$70.15 |
| Rate for Payer: Aetna Commercial |
$66.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.66
|
| Rate for Payer: BCBS Complete |
$31.18
|
| Rate for Payer: BCBS Trust/PPO |
$20.20
|
| Rate for Payer: Cash Price |
$62.35
|
| Rate for Payer: Cash Price |
$62.35
|
| Rate for Payer: Cofinity Commercial |
$54.56
|
| Rate for Payer: Cofinity Commercial |
$67.03
|
| Rate for Payer: Healthscope Commercial |
$70.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.25
|
| Rate for Payer: PHP Commercial |
$66.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.56
|
| Rate for Payer: Priority Health SBD |
$49.10
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
IP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$471.58 |
| Max. Negotiated Rate |
$673.69 |
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.55
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$523.98
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$636.26
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.98
|
| Rate for Payer: Priority Health SBD |
$471.58
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
OP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.42 |
| Max. Negotiated Rate |
$673.69 |
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.55
|
| Rate for Payer: BCBS Complete |
$299.42
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$523.98
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$636.26
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.98
|
| Rate for Payer: Priority Health SBD |
$471.58
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
OP
|
$898.41
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,932.06 |
| Rate for Payer: Aetna Commercial |
$763.65
|
| Rate for Payer: Aetna Commercial |
$725.59
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$530.21
|
| Rate for Payer: BCBS Trust/PPO |
$530.21
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$682.90
|
| Rate for Payer: Cash Price |
$682.90
|
| Rate for Payer: Cash Price |
$718.73
|
| Rate for Payer: Cash Price |
$718.73
|
| Rate for Payer: Cofinity Commercial |
$772.63
|
| Rate for Payer: Cofinity Commercial |
$628.89
|
| Rate for Payer: Cofinity Commercial |
$597.54
|
| Rate for Payer: Cofinity Commercial |
$734.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$768.27
|
| Rate for Payer: Healthscope Commercial |
$808.57
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$725.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$763.65
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$763.65
|
| Rate for Payer: PHP Commercial |
$725.59
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,932.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,932.06
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.65
|
| Rate for Payer: Priority Health SBD |
$537.79
|
| Rate for Payer: Priority Health SBD |
$566.00
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
IP
|
$898.41
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$566.00 |
| Max. Negotiated Rate |
$808.57 |
| Rate for Payer: Aetna Commercial |
$763.65
|
| Rate for Payer: Aetna Commercial |
$725.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.86
|
| Rate for Payer: Cash Price |
$718.73
|
| Rate for Payer: Cash Price |
$682.90
|
| Rate for Payer: Cofinity Commercial |
$772.63
|
| Rate for Payer: Cofinity Commercial |
$597.54
|
| Rate for Payer: Cofinity Commercial |
$734.12
|
| Rate for Payer: Cofinity Commercial |
$628.89
|
| Rate for Payer: Healthscope Commercial |
$768.27
|
| Rate for Payer: Healthscope Commercial |
$808.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$725.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$763.65
|
| Rate for Payer: PHP Commercial |
$763.65
|
| Rate for Payer: PHP Commercial |
$725.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.54
|
| Rate for Payer: Priority Health SBD |
$566.00
|
| Rate for Payer: Priority Health SBD |
$537.79
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
IP
|
$755.88
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$476.20 |
| Max. Negotiated Rate |
$680.29 |
| Rate for Payer: Aetna Commercial |
$642.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.32
|
| Rate for Payer: Cash Price |
$604.70
|
| Rate for Payer: Cofinity Commercial |
$529.12
|
| Rate for Payer: Cofinity Commercial |
$650.06
|
| Rate for Payer: Healthscope Commercial |
$680.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$642.50
|
| Rate for Payer: PHP Commercial |
$642.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.12
|
| Rate for Payer: Priority Health SBD |
$476.20
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
OP
|
$755.88
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.05 |
| Max. Negotiated Rate |
$1,932.06 |
| Rate for Payer: Aetna Commercial |
$642.50
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$237.92
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$604.70
|
| Rate for Payer: Cash Price |
$604.70
|
| Rate for Payer: Cofinity Commercial |
$650.06
|
| Rate for Payer: Cofinity Commercial |
$529.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$680.29
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$642.50
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$642.50
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,932.06
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.65
|
| Rate for Payer: Priority Health SBD |
$476.20
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$90.05
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
IP
|
$2,066.60
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.96 |
| Max. Negotiated Rate |
$1,859.94 |
| Rate for Payer: Aetna Commercial |
$1,756.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,343.29
|
| Rate for Payer: Cash Price |
$1,653.28
|
| Rate for Payer: Cofinity Commercial |
$1,446.62
|
| Rate for Payer: Cofinity Commercial |
$1,777.28
|
| Rate for Payer: Healthscope Commercial |
$1,859.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,756.61
|
| Rate for Payer: PHP Commercial |
$1,756.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,446.62
|
| Rate for Payer: Priority Health SBD |
$1,301.96
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
OP
|
$2,066.60
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.04 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Commercial |
$1,756.61
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,343.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$562.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$1,653.28
|
| Rate for Payer: Cash Price |
$1,653.28
|
| Rate for Payer: Cofinity Commercial |
$1,777.28
|
| Rate for Payer: Cofinity Commercial |
$1,446.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$1,859.94
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,756.61
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$1,756.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,446.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$1,301.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.64
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$146.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.48
|
| Rate for Payer: BCBS Complete |
$10.33
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$14.08
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Mclaren Medicaid |
$9.84
|
| Rate for Payer: Mclaren Medicare |
$17.98
|
| Rate for Payer: Meridian Medicaid |
$10.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.00
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.58
|
| Rate for Payer: UHC Core |
$30.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Exchange |
$17.98
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.38 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna Medicare |
$50.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.28
|
| Rate for Payer: BCBS Complete |
$27.70
|
| Rate for Payer: BCBS MAPPO |
$48.22
|
| Rate for Payer: BCBS Trust/PPO |
$52.24
|
| Rate for Payer: BCCCP Commercial |
$71.93
|
| Rate for Payer: BCN Medicare Advantage |
$48.22
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.22
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Mclaren Medicaid |
$26.38
|
| Rate for Payer: Mclaren Medicare |
$48.22
|
| Rate for Payer: Meridian Medicaid |
$27.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.25
|
| Rate for Payer: PACE Medicare |
$45.81
|
| Rate for Payer: PACE SWMI |
$48.22
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: PHP Medicare Advantage |
$48.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.72
|
| Rate for Payer: Priority Health Medicare |
$48.22
|
| Rate for Payer: Priority Health Narrow Network |
$123.78
|
| Rate for Payer: Priority Health SBD |
$192.15
|
| Rate for Payer: Railroad Medicare Medicare |
$48.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.44
|
| Rate for Payer: UHC Core |
$44.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.22
|
| Rate for Payer: UHC Exchange |
$70.40
|
| Rate for Payer: UHC Medicare Advantage |
$49.67
|
| Rate for Payer: VA VA |
$48.22
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$192.15 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.50
|
| Rate for Payer: Priority Health SBD |
$192.15
|
|
|
HC LVAD INSERTION
|
Facility
|
OP
|
$3,160.43
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.45 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$2,686.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,054.28
|
| Rate for Payer: BCBS Complete |
$1,264.17
|
| Rate for Payer: BCBS Trust/PPO |
$873.88
|
| Rate for Payer: Cash Price |
$2,528.34
|
| Rate for Payer: Cash Price |
$2,528.34
|
| Rate for Payer: Cofinity Commercial |
$2,717.97
|
| Rate for Payer: Cofinity Commercial |
$2,212.30
|
| Rate for Payer: Healthscope Commercial |
$2,844.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,686.37
|
| Rate for Payer: PHP Commercial |
$2,686.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,212.30
|
| Rate for Payer: Priority Health SBD |
$1,991.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.00
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$345.45
|
|
|
HC LVAD INSERTION
|
Facility
|
IP
|
$3,160.43
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,991.07 |
| Max. Negotiated Rate |
$2,844.39 |
| Rate for Payer: Aetna Commercial |
$2,686.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,054.28
|
| Rate for Payer: Cash Price |
$2,528.34
|
| Rate for Payer: Cofinity Commercial |
$2,212.30
|
| Rate for Payer: Cofinity Commercial |
$2,717.97
|
| Rate for Payer: Healthscope Commercial |
$2,844.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,686.37
|
| Rate for Payer: PHP Commercial |
$2,686.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,212.30
|
| Rate for Payer: Priority Health SBD |
$1,991.07
|
|
|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
IP
|
$2,777.25
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,749.67 |
| Max. Negotiated Rate |
$2,499.52 |
| Rate for Payer: Aetna Commercial |
$2,360.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,805.21
|
| Rate for Payer: Cash Price |
$2,221.80
|
| Rate for Payer: Cofinity Commercial |
$1,944.08
|
| Rate for Payer: Cofinity Commercial |
$2,388.44
|
| Rate for Payer: Healthscope Commercial |
$2,499.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,360.66
|
| Rate for Payer: PHP Commercial |
$2,360.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,944.08
|
| Rate for Payer: Priority Health SBD |
$1,749.67
|
|
|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
OP
|
$2,777.25
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$343.53 |
| Max. Negotiated Rate |
$2,499.52 |
| Rate for Payer: Aetna Commercial |
$2,360.66
|
| Rate for Payer: Aetna Medicare |
$653.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,805.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$785.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$785.02
|
| Rate for Payer: BCBS Complete |
$360.73
|
| Rate for Payer: BCBS MAPPO |
$628.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,854.39
|
| Rate for Payer: BCN Medicare Advantage |
$628.02
|
| Rate for Payer: Cash Price |
$2,221.80
|
| Rate for Payer: Cash Price |
$2,221.80
|
| Rate for Payer: Cofinity Commercial |
$2,388.44
|
| Rate for Payer: Cofinity Commercial |
$1,944.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$628.02
|
| Rate for Payer: Healthscope Commercial |
$2,499.52
|
| Rate for Payer: Mclaren Medicaid |
$343.53
|
| Rate for Payer: Mclaren Medicare |
$628.02
|
| Rate for Payer: Meridian Medicaid |
$360.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$659.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$722.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,360.66
|
| Rate for Payer: PACE Medicare |
$596.62
|
| Rate for Payer: PACE SWMI |
$628.02
|
| Rate for Payer: PHP Commercial |
$2,360.66
|
| Rate for Payer: PHP Medicare Advantage |
$628.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,944.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,913.64
|
| Rate for Payer: Priority Health Medicare |
$628.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,530.91
|
| Rate for Payer: Priority Health SBD |
$1,749.67
|
| Rate for Payer: Railroad Medicare Medicare |
$628.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$628.02
|
| Rate for Payer: UHC Medicare Advantage |
$646.86
|
| Rate for Payer: VA VA |
$628.02
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
OP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$241.28 |
| Max. Negotiated Rate |
$1,941.22 |
| Rate for Payer: Aetna Commercial |
$1,833.37
|
| Rate for Payer: Aetna Medicare |
$458.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,401.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$551.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$551.38
|
| Rate for Payer: BCBS Complete |
$253.37
|
| Rate for Payer: BCBS MAPPO |
$441.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,411.18
|
| Rate for Payer: BCN Medicare Advantage |
$441.10
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$1,854.94
|
| Rate for Payer: Cofinity Commercial |
$1,509.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.10
|
| Rate for Payer: Healthscope Commercial |
$1,941.22
|
| Rate for Payer: Mclaren Medicaid |
$241.28
|
| Rate for Payer: Mclaren Medicare |
$441.10
|
| Rate for Payer: Meridian Medicaid |
$253.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$463.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,833.37
|
| Rate for Payer: PACE Medicare |
$419.04
|
| Rate for Payer: PACE SWMI |
$441.10
|
| Rate for Payer: PHP Commercial |
$1,833.37
|
| Rate for Payer: PHP Medicare Advantage |
$441.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,456.27
|
| Rate for Payer: Priority Health Medicare |
$441.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,165.02
|
| Rate for Payer: Priority Health SBD |
$1,358.85
|
| Rate for Payer: Railroad Medicare Medicare |
$441.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.10
|
| Rate for Payer: UHC Medicare Advantage |
$454.33
|
| Rate for Payer: VA VA |
$441.10
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
IP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,358.85 |
| Max. Negotiated Rate |
$1,941.22 |
| Rate for Payer: Aetna Commercial |
$1,833.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,401.99
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$1,509.84
|
| Rate for Payer: Cofinity Commercial |
$1,854.94
|
| Rate for Payer: Healthscope Commercial |
$1,941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,833.37
|
| Rate for Payer: PHP Commercial |
$1,833.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.84
|
| Rate for Payer: Priority Health SBD |
$1,358.85
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
OP
|
$8,832.18
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$442.37 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna Commercial |
$7,507.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,740.92
|
| Rate for Payer: BCBS Complete |
$3,532.87
|
| Rate for Payer: BCBS Trust/PPO |
$10,224.07
|
| Rate for Payer: Cash Price |
$7,065.74
|
| Rate for Payer: Cash Price |
$7,065.74
|
| Rate for Payer: Cofinity Commercial |
$7,595.67
|
| Rate for Payer: Cofinity Commercial |
$6,182.53
|
| Rate for Payer: Healthscope Commercial |
$7,948.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,507.35
|
| Rate for Payer: PHP Commercial |
$7,507.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,182.53
|
| Rate for Payer: Priority Health SBD |
$5,564.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.61
|
| Rate for Payer: UHC Core |
$10,600.00
|
| Rate for Payer: UHC Exchange |
$442.37
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
IP
|
$8,832.18
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,564.27 |
| Max. Negotiated Rate |
$7,948.96 |
| Rate for Payer: Aetna Commercial |
$7,507.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,740.92
|
| Rate for Payer: Cash Price |
$7,065.74
|
| Rate for Payer: Cofinity Commercial |
$6,182.53
|
| Rate for Payer: Cofinity Commercial |
$7,595.67
|
| Rate for Payer: Healthscope Commercial |
$7,948.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,507.35
|
| Rate for Payer: PHP Commercial |
$7,507.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,182.53
|
| Rate for Payer: Priority Health SBD |
$5,564.27
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
OP
|
$3,518.07
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$469.88 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$2,990.36
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,286.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,107.31
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$2,814.46
|
| Rate for Payer: Cash Price |
$2,814.46
|
| Rate for Payer: Cofinity Commercial |
$3,025.54
|
| Rate for Payer: Cofinity Commercial |
$2,462.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$3,166.26
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,990.36
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$2,990.36
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,462.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$2,216.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.87
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$469.88
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
IP
|
$3,518.07
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,216.38 |
| Max. Negotiated Rate |
$3,166.26 |
| Rate for Payer: Aetna Commercial |
$2,990.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,286.75
|
| Rate for Payer: Cash Price |
$2,814.46
|
| Rate for Payer: Cofinity Commercial |
$2,462.65
|
| Rate for Payer: Cofinity Commercial |
$3,025.54
|
| Rate for Payer: Healthscope Commercial |
$3,166.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,990.36
|
| Rate for Payer: PHP Commercial |
$2,990.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,462.65
|
| Rate for Payer: Priority Health SBD |
$2,216.38
|
|
