|
HC I-131 SOL (TX) PER MCI
|
Facility
|
IP
|
$47.87
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$43.08 |
| Rate for Payer: Aetna Commercial |
$40.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$33.51
|
| Rate for Payer: Cofinity Commercial |
$41.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: PHP Commercial |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health SBD |
$30.16
|
|
|
HC IAAD NOS EACH ORGANISM AG IA
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600341
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC IAAD NOS EACH ORGANISM AG IA
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600341
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health SBD |
$66.15
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
IP
|
$408.67
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$257.46 |
| Max. Negotiated Rate |
$367.80 |
| Rate for Payer: Aetna Commercial |
$347.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.64
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$286.07
|
| Rate for Payer: Cofinity Commercial |
$351.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.94
|
| Rate for Payer: Healthscope Commercial |
$367.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.37
|
| Rate for Payer: PHP Commercial |
$347.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.64
|
| Rate for Payer: Priority Health SBD |
$257.46
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
OP
|
$408.67
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.47 |
| Max. Negotiated Rate |
$367.80 |
| Rate for Payer: Aetna Commercial |
$347.37
|
| Rate for Payer: Aetna Medicare |
$204.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.64
|
| Rate for Payer: BCBS Complete |
$163.47
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$286.07
|
| Rate for Payer: Cofinity Commercial |
$351.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.94
|
| Rate for Payer: Healthscope Commercial |
$367.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.37
|
| Rate for Payer: PHP Commercial |
$347.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.64
|
| Rate for Payer: Priority Health SBD |
$257.46
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
OP
|
$398.44
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$173.39 |
| Max. Negotiated Rate |
$910.59 |
| Rate for Payer: Aetna Commercial |
$338.67
|
| Rate for Payer: Aetna Medicare |
$336.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| Rate for Payer: Cash Price |
$318.75
|
| Rate for Payer: Cash Price |
$318.75
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Cofinity Commercial |
$278.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.49
|
| Rate for Payer: Healthscope Commercial |
$358.60
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.67
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Commercial |
$338.67
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.99
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Priority Health SBD |
$251.02
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.59
|
| Rate for Payer: UHC Core |
$294.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Exchange |
$294.85
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$182.12
|
| Rate for Payer: VA VA |
$323.49
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
IP
|
$398.44
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$251.02 |
| Max. Negotiated Rate |
$358.60 |
| Rate for Payer: Aetna Commercial |
$338.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.99
|
| Rate for Payer: Cash Price |
$318.75
|
| Rate for Payer: Cofinity Commercial |
$278.91
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.75
|
| Rate for Payer: Healthscope Commercial |
$358.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.67
|
| Rate for Payer: PHP Commercial |
$338.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.99
|
| Rate for Payer: Priority Health SBD |
$251.02
|
|
|
HC IBD DIFF
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health SBD |
$39.20
|
|
|
HC IBD DIFF
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC IBD DIFFERENTIATION
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200174
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health SBD |
$39.20
|
|
|
HC IBD DIFFERENTIATION
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200174
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC IBD DIFFERENTIATION CMPT
|
Facility
|
OP
|
$58.14
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: Aetna Medicare |
$12.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.31
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS MAPPO |
$12.25
|
| Rate for Payer: BCN Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Cofinity Commercial |
$40.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Mclaren Medicaid |
$6.57
|
| Rate for Payer: Mclaren Medicare |
$12.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.86
|
| Rate for Payer: Meridian Medicaid |
$6.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: PACE Medicare |
$11.64
|
| Rate for Payer: PACE SWMI |
$12.25
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: PHP Medicare Advantage |
$12.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.79
|
| Rate for Payer: Priority Health Medicare |
$12.25
|
| Rate for Payer: Priority Health SBD |
$36.63
|
| Rate for Payer: Railroad Medicare Medicare |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.25
|
| Rate for Payer: UHC Medicare Advantage |
$12.25
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.25
|
|
|
HC IBD DIFFERENTIATION CMPT
|
Facility
|
IP
|
$58.14
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.63 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.79
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$40.70
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.79
|
| Rate for Payer: Priority Health SBD |
$36.63
|
|
|
HC ICD CRT/DUAL IMPLANT/REPLACE
|
Facility
|
OP
|
$26,928.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16,760.19 |
| Max. Negotiated Rate |
$88,019.16 |
| Rate for Payer: Aetna Commercial |
$22,888.80
|
| Rate for Payer: Aetna Medicare |
$32,519.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,503.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,086.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,086.28
|
| Rate for Payer: BCBS Complete |
$17,598.20
|
| Rate for Payer: BCBS MAPPO |
$31,269.02
|
| Rate for Payer: BCN Medicare Advantage |
$31,269.02
|
| Rate for Payer: Cash Price |
$21,542.40
|
| Rate for Payer: Cash Price |
$21,542.40
|
| Rate for Payer: Cofinity Commercial |
$23,158.08
|
| Rate for Payer: Cofinity Commercial |
$18,849.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,849.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,542.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,269.02
|
| Rate for Payer: Healthscope Commercial |
$24,235.20
|
| Rate for Payer: Mclaren Medicaid |
$16,760.19
|
| Rate for Payer: Mclaren Medicare |
$31,269.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,832.47
|
| Rate for Payer: Meridian Medicaid |
$17,598.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,959.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,888.80
|
| Rate for Payer: PACE Medicare |
$29,705.57
|
| Rate for Payer: PACE SWMI |
$31,269.02
|
| Rate for Payer: PHP Commercial |
$22,888.80
|
| Rate for Payer: PHP Medicare Advantage |
$31,269.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,760.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,503.20
|
| Rate for Payer: Priority Health Medicare |
$31,269.02
|
| Rate for Payer: Priority Health SBD |
$16,964.64
|
| Rate for Payer: Railroad Medicare Medicare |
$31,269.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88,019.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$31,269.02
|
| Rate for Payer: UHC Medicare Advantage |
$31,269.02
|
| Rate for Payer: UHCCP Medicaid |
$17,604.46
|
| Rate for Payer: VA VA |
$31,269.02
|
|
|
HC ICD CRT/DUAL IMPLANT/REPLACE
|
Facility
|
IP
|
$26,928.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16,964.64 |
| Max. Negotiated Rate |
$24,235.20 |
| Rate for Payer: Aetna Commercial |
$22,888.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,503.20
|
| Rate for Payer: Cash Price |
$21,542.40
|
| Rate for Payer: Cofinity Commercial |
$18,849.60
|
| Rate for Payer: Cofinity Commercial |
$23,158.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,849.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,542.40
|
| Rate for Payer: Healthscope Commercial |
$24,235.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,888.80
|
| Rate for Payer: PHP Commercial |
$22,888.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,503.20
|
| Rate for Payer: Priority Health SBD |
$16,964.64
|
|
|
HC ICD CRT/DUAL REPLACEMENT
|
Facility
|
IP
|
$11,444.40
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
36100075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,209.97 |
| Max. Negotiated Rate |
$10,299.96 |
| Rate for Payer: Aetna Commercial |
$9,727.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,438.86
|
| Rate for Payer: Cash Price |
$9,155.52
|
| Rate for Payer: Cofinity Commercial |
$8,011.08
|
| Rate for Payer: Cofinity Commercial |
$9,842.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,011.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,155.52
|
| Rate for Payer: Healthscope Commercial |
$10,299.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,727.74
|
| Rate for Payer: PHP Commercial |
$9,727.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,438.86
|
| Rate for Payer: Priority Health SBD |
$7,209.97
|
|
|
HC ICD CRT/DUAL REPLACEMENT
|
Facility
|
OP
|
$11,444.40
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
36100075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,209.97 |
| Max. Negotiated Rate |
$61,621.88 |
| Rate for Payer: Aetna Commercial |
$9,727.74
|
| Rate for Payer: Aetna Medicare |
$22,766.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,438.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,364.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,364.15
|
| Rate for Payer: BCBS Complete |
$12,320.43
|
| Rate for Payer: BCBS MAPPO |
$21,891.32
|
| Rate for Payer: BCN Medicare Advantage |
$21,891.32
|
| Rate for Payer: Cash Price |
$9,155.52
|
| Rate for Payer: Cash Price |
$9,155.52
|
| Rate for Payer: Cofinity Commercial |
$9,842.18
|
| Rate for Payer: Cofinity Commercial |
$8,011.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,011.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,155.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,891.32
|
| Rate for Payer: Healthscope Commercial |
$10,299.96
|
| Rate for Payer: Mclaren Medicaid |
$11,733.75
|
| Rate for Payer: Mclaren Medicare |
$21,891.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,985.89
|
| Rate for Payer: Meridian Medicaid |
$12,320.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,175.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,727.74
|
| Rate for Payer: PACE Medicare |
$20,796.75
|
| Rate for Payer: PACE SWMI |
$21,891.32
|
| Rate for Payer: PHP Commercial |
$9,727.74
|
| Rate for Payer: PHP Medicare Advantage |
$21,891.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,733.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,438.86
|
| Rate for Payer: Priority Health Medicare |
$21,891.32
|
| Rate for Payer: Priority Health SBD |
$7,209.97
|
| Rate for Payer: Railroad Medicare Medicare |
$21,891.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61,621.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,891.32
|
| Rate for Payer: UHC Medicare Advantage |
$21,891.32
|
| Rate for Payer: UHCCP Medicaid |
$12,324.81
|
| Rate for Payer: VA VA |
$21,891.32
|
|
|
HC ICD LEAD REMOVAL
|
Facility
|
OP
|
$2,717.88
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
36100078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,712.26 |
| Max. Negotiated Rate |
$9,991.04 |
| Rate for Payer: Aetna Commercial |
$2,310.20
|
| Rate for Payer: Aetna Medicare |
$3,691.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,766.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,436.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,436.68
|
| Rate for Payer: BCBS Complete |
$1,997.57
|
| Rate for Payer: BCBS MAPPO |
$3,549.34
|
| Rate for Payer: BCN Medicare Advantage |
$3,549.34
|
| Rate for Payer: Cash Price |
$2,174.30
|
| Rate for Payer: Cash Price |
$2,174.30
|
| Rate for Payer: Cofinity Commercial |
$2,337.38
|
| Rate for Payer: Cofinity Commercial |
$1,902.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,902.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,174.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,549.34
|
| Rate for Payer: Healthscope Commercial |
$2,446.09
|
| Rate for Payer: Mclaren Medicaid |
$1,902.45
|
| Rate for Payer: Mclaren Medicare |
$3,549.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,726.81
|
| Rate for Payer: Meridian Medicaid |
$1,997.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,081.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,310.20
|
| Rate for Payer: PACE Medicare |
$3,371.87
|
| Rate for Payer: PACE SWMI |
$3,549.34
|
| Rate for Payer: PHP Commercial |
$2,310.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,549.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,902.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,766.62
|
| Rate for Payer: Priority Health Medicare |
$3,549.34
|
| Rate for Payer: Priority Health SBD |
$1,712.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3,549.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,991.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,549.34
|
| Rate for Payer: UHC Medicare Advantage |
$3,549.34
|
| Rate for Payer: UHCCP Medicaid |
$1,998.28
|
| Rate for Payer: VA VA |
$3,549.34
|
|
|
HC ICD LEAD REMOVAL
|
Facility
|
IP
|
$2,717.88
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
36100078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,712.26 |
| Max. Negotiated Rate |
$2,446.09 |
| Rate for Payer: Aetna Commercial |
$2,310.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,766.62
|
| Rate for Payer: Cash Price |
$2,174.30
|
| Rate for Payer: Cofinity Commercial |
$1,902.52
|
| Rate for Payer: Cofinity Commercial |
$2,337.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,902.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,174.30
|
| Rate for Payer: Healthscope Commercial |
$2,446.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,310.20
|
| Rate for Payer: PHP Commercial |
$2,310.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,766.62
|
| Rate for Payer: Priority Health SBD |
$1,712.26
|
|
|
HC ICD POCKET REVISION
|
Facility
|
IP
|
$3,164.22
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
36100068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,993.46 |
| Max. Negotiated Rate |
$2,847.80 |
| Rate for Payer: Aetna Commercial |
$2,689.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,056.74
|
| Rate for Payer: Cash Price |
$2,531.38
|
| Rate for Payer: Cofinity Commercial |
$2,214.95
|
| Rate for Payer: Cofinity Commercial |
$2,721.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,214.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,531.38
|
| Rate for Payer: Healthscope Commercial |
$2,847.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,689.59
|
| Rate for Payer: PHP Commercial |
$2,689.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,056.74
|
| Rate for Payer: Priority Health SBD |
$1,993.46
|
|
|
HC ICD POCKET REVISION
|
Facility
|
OP
|
$3,164.22
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
36100068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Commercial |
$2,689.59
|
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,056.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$2,531.38
|
| Rate for Payer: Cash Price |
$2,531.38
|
| Rate for Payer: Cofinity Commercial |
$2,721.23
|
| Rate for Payer: Cofinity Commercial |
$2,214.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,214.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,531.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$2,847.80
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,689.59
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$2,689.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,056.74
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health SBD |
$1,993.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$1,004.40
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
HC ICD SINGLE IMPLANT
|
Facility
|
OP
|
$19,074.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,016.62 |
| Max. Negotiated Rate |
$88,019.16 |
| Rate for Payer: Aetna Commercial |
$16,212.90
|
| Rate for Payer: Aetna Medicare |
$32,519.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,398.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,086.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,086.28
|
| Rate for Payer: BCBS Complete |
$17,598.20
|
| Rate for Payer: BCBS MAPPO |
$31,269.02
|
| Rate for Payer: BCN Medicare Advantage |
$31,269.02
|
| Rate for Payer: Cash Price |
$15,259.20
|
| Rate for Payer: Cash Price |
$15,259.20
|
| Rate for Payer: Cofinity Commercial |
$16,403.64
|
| Rate for Payer: Cofinity Commercial |
$13,351.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,351.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,259.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,269.02
|
| Rate for Payer: Healthscope Commercial |
$17,166.60
|
| Rate for Payer: Mclaren Medicaid |
$16,760.19
|
| Rate for Payer: Mclaren Medicare |
$31,269.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,832.47
|
| Rate for Payer: Meridian Medicaid |
$17,598.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,959.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,212.90
|
| Rate for Payer: PACE Medicare |
$29,705.57
|
| Rate for Payer: PACE SWMI |
$31,269.02
|
| Rate for Payer: PHP Commercial |
$16,212.90
|
| Rate for Payer: PHP Medicare Advantage |
$31,269.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,760.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,398.10
|
| Rate for Payer: Priority Health Medicare |
$31,269.02
|
| Rate for Payer: Priority Health SBD |
$12,016.62
|
| Rate for Payer: Railroad Medicare Medicare |
$31,269.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88,019.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$31,269.02
|
| Rate for Payer: UHC Medicare Advantage |
$31,269.02
|
| Rate for Payer: UHCCP Medicaid |
$17,604.46
|
| Rate for Payer: VA VA |
$31,269.02
|
|
|
HC ICD SINGLE IMPLANT
|
Facility
|
IP
|
$19,074.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,016.62 |
| Max. Negotiated Rate |
$17,166.60 |
| Rate for Payer: Aetna Commercial |
$16,212.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,398.10
|
| Rate for Payer: Cash Price |
$15,259.20
|
| Rate for Payer: Cofinity Commercial |
$13,351.80
|
| Rate for Payer: Cofinity Commercial |
$16,403.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,351.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,259.20
|
| Rate for Payer: Healthscope Commercial |
$17,166.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,212.90
|
| Rate for Payer: PHP Commercial |
$16,212.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,398.10
|
| Rate for Payer: Priority Health SBD |
$12,016.62
|
|
|
HC ICP MONITOR
|
Facility
|
OP
|
$1,996.65
|
|
| Hospital Charge Code |
27800143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.66 |
| Max. Negotiated Rate |
$1,796.98 |
| Rate for Payer: Aetna Commercial |
$1,697.15
|
| Rate for Payer: Aetna Medicare |
$998.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,297.82
|
| Rate for Payer: BCBS Complete |
$798.66
|
| Rate for Payer: Cash Price |
$1,597.32
|
| Rate for Payer: Cofinity Commercial |
$1,397.65
|
| Rate for Payer: Cofinity Commercial |
$1,717.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,397.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,597.32
|
| Rate for Payer: Healthscope Commercial |
$1,796.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,697.15
|
| Rate for Payer: PHP Commercial |
$1,697.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.82
|
| Rate for Payer: Priority Health SBD |
$1,257.89
|
|
|
HC ICP MONITOR
|
Facility
|
IP
|
$1,996.65
|
|
| Hospital Charge Code |
27800143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.89 |
| Max. Negotiated Rate |
$1,796.98 |
| Rate for Payer: Aetna Commercial |
$1,697.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,297.82
|
| Rate for Payer: Cash Price |
$1,597.32
|
| Rate for Payer: Cofinity Commercial |
$1,397.65
|
| Rate for Payer: Cofinity Commercial |
$1,717.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,397.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,597.32
|
| Rate for Payer: Healthscope Commercial |
$1,796.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,697.15
|
| Rate for Payer: PHP Commercial |
$1,697.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.82
|
| Rate for Payer: Priority Health SBD |
$1,257.89
|
|
