|
HC LC/CABG'S W INTERVENTION
|
Facility
|
IP
|
$11,233.61
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,077.17 |
| Max. Negotiated Rate |
$10,110.25 |
| Rate for Payer: Aetna Commercial |
$9,548.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,301.85
|
| Rate for Payer: Cash Price |
$8,986.89
|
| Rate for Payer: Cofinity Advantage |
$7,863.53
|
| Rate for Payer: Cofinity Commercial |
$9,660.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,986.89
|
| Rate for Payer: Healthscope Commercial |
$10,110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,548.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,425.21
|
| Rate for Payer: PHP Commercial |
$9,548.57
|
| Rate for Payer: Priority Health SBD |
$7,077.17
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
OP
|
$11,233.61
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.43 |
| Max. Negotiated Rate |
$10,446.41 |
| Rate for Payer: Aetna Commercial |
$9,548.57
|
| Rate for Payer: Aetna Medicare |
$3,359.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,301.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,037.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,037.84
|
| Rate for Payer: BCBS Complete |
$1,774.06
|
| Rate for Payer: BCBS MAPPO |
$3,230.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,304.40
|
| Rate for Payer: BCN Commercial |
$3,304.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,230.27
|
| Rate for Payer: Cash Price |
$8,986.89
|
| Rate for Payer: Cash Price |
$8,986.89
|
| Rate for Payer: Cofinity Advantage |
$7,863.53
|
| Rate for Payer: Cofinity Commercial |
$9,660.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,986.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,230.27
|
| Rate for Payer: Healthscope Commercial |
$10,110.25
|
| Rate for Payer: Mclaren Medicaid |
$1,689.43
|
| Rate for Payer: Mclaren Medicare |
$3,230.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,391.78
|
| Rate for Payer: Meridian Medicaid |
$3,391.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,714.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,553.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,548.57
|
| Rate for Payer: Nomi Health Commercial |
$9,690.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,425.21
|
| Rate for Payer: PACE Medicare |
$3,068.76
|
| Rate for Payer: PACE SWMI |
$3,230.27
|
| Rate for Payer: PHP Commercial |
$9,548.57
|
| Rate for Payer: PHP Medicare Advantage |
$3,230.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,689.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,446.41
|
| Rate for Payer: Priority Health Medicare |
$3,230.27
|
| Rate for Payer: Priority Health SBD |
$7,077.17
|
| Rate for Payer: Priority Health Tiered Network |
$8,357.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3,230.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,230.27
|
| Rate for Payer: UHC Medicaid |
$1,689.43
|
| Rate for Payer: UHCCP Medicaid |
$1,689.43
|
| Rate for Payer: VA VA |
$3,230.27
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
OP
|
$60.97
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$54.87 |
| Rate for Payer: Aetna Commercial |
$51.82
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.12
|
| Rate for Payer: BCBS Complete |
$5.77
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$11.20
|
| Rate for Payer: BCN Commercial |
$11.20
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$48.78
|
| Rate for Payer: Cash Price |
$48.78
|
| Rate for Payer: Cofinity Advantage |
$42.68
|
| Rate for Payer: Cofinity Commercial |
$52.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$54.87
|
| Rate for Payer: Mclaren Medicaid |
$5.49
|
| Rate for Payer: Mclaren Medicare |
$10.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.03
|
| Rate for Payer: Meridian Medicaid |
$11.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.82
|
| Rate for Payer: Nomi Health Commercial |
$15.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.73
|
| Rate for Payer: PACE Medicare |
$9.97
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$51.82
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.50
|
| Rate for Payer: Priority Health Medicare |
$10.50
|
| Rate for Payer: Priority Health SBD |
$38.41
|
| Rate for Payer: Priority Health Tiered Network |
$8.40
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.75
|
| Rate for Payer: UHC Core |
$15.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.50
|
| Rate for Payer: UHC Exchange |
$15.75
|
| Rate for Payer: UHC Medicaid |
$5.49
|
| Rate for Payer: UHCCP Medicaid |
$5.49
|
| Rate for Payer: VA VA |
$10.50
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
IP
|
$60.97
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.41 |
| Max. Negotiated Rate |
$54.87 |
| Rate for Payer: Aetna Commercial |
$51.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.63
|
| Rate for Payer: Cash Price |
$48.78
|
| Rate for Payer: Cofinity Advantage |
$42.68
|
| Rate for Payer: Cofinity Commercial |
$52.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.78
|
| Rate for Payer: Healthscope Commercial |
$54.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.73
|
| Rate for Payer: PHP Commercial |
$51.82
|
| Rate for Payer: Priority Health SBD |
$38.41
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
IP
|
$1,499.27
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$944.54 |
| Max. Negotiated Rate |
$1,349.34 |
| Rate for Payer: Aetna Commercial |
$1,274.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.53
|
| Rate for Payer: Cash Price |
$1,199.42
|
| Rate for Payer: Cofinity Advantage |
$1,049.49
|
| Rate for Payer: Cofinity Commercial |
$1,289.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.42
|
| Rate for Payer: Healthscope Commercial |
$1,349.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.45
|
| Rate for Payer: PHP Commercial |
$1,274.38
|
| Rate for Payer: Priority Health SBD |
$944.54
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
OP
|
$1,499.27
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$589.21 |
| Max. Negotiated Rate |
$1,349.34 |
| Rate for Payer: Aetna Commercial |
$1,274.38
|
| Rate for Payer: Aetna Medicare |
$749.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.53
|
| Rate for Payer: BCBS Complete |
$599.71
|
| Rate for Payer: Cash Price |
$1,199.42
|
| Rate for Payer: Cofinity Advantage |
$1,049.49
|
| Rate for Payer: Cofinity Commercial |
$1,289.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.42
|
| Rate for Payer: Healthscope Commercial |
$1,349.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,199.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.45
|
| Rate for Payer: PHP Commercial |
$1,274.38
|
| Rate for Payer: Priority Health SBD |
$944.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.53
|
| Rate for Payer: UHC Core |
$781.12
|
| Rate for Payer: UHC Exchange |
$589.21
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
IP
|
$3,747.95
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,361.21 |
| Max. Negotiated Rate |
$3,373.16 |
| Rate for Payer: Aetna Commercial |
$3,185.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,436.17
|
| Rate for Payer: Cash Price |
$2,998.36
|
| Rate for Payer: Cofinity Advantage |
$2,623.57
|
| Rate for Payer: Cofinity Commercial |
$3,223.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,998.36
|
| Rate for Payer: Healthscope Commercial |
$3,373.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,185.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,810.96
|
| Rate for Payer: PHP Commercial |
$3,185.76
|
| Rate for Payer: Priority Health SBD |
$2,361.21
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
OP
|
$3,747.95
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,472.94 |
| Max. Negotiated Rate |
$3,373.16 |
| Rate for Payer: Aetna Commercial |
$3,185.76
|
| Rate for Payer: Aetna Medicare |
$1,873.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,436.17
|
| Rate for Payer: BCBS Complete |
$1,499.18
|
| Rate for Payer: Cash Price |
$2,998.36
|
| Rate for Payer: Cofinity Advantage |
$2,623.57
|
| Rate for Payer: Cofinity Commercial |
$3,223.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,998.36
|
| Rate for Payer: Healthscope Commercial |
$3,373.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,998.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,185.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,810.96
|
| Rate for Payer: PHP Commercial |
$3,185.76
|
| Rate for Payer: Priority Health SBD |
$2,361.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,436.17
|
| Rate for Payer: UHC Core |
$1,952.68
|
| Rate for Payer: UHC Exchange |
$1,472.94
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
OP
|
$2,998.26
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,178.32 |
| Max. Negotiated Rate |
$2,698.43 |
| Rate for Payer: Aetna Commercial |
$2,548.52
|
| Rate for Payer: Aetna Medicare |
$1,499.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,948.87
|
| Rate for Payer: BCBS Complete |
$1,199.30
|
| Rate for Payer: Cash Price |
$2,398.61
|
| Rate for Payer: Cofinity Advantage |
$2,098.78
|
| Rate for Payer: Cofinity Commercial |
$2,578.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,398.61
|
| Rate for Payer: Healthscope Commercial |
$2,698.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,398.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,548.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,248.70
|
| Rate for Payer: PHP Commercial |
$2,548.52
|
| Rate for Payer: Priority Health SBD |
$1,888.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,948.87
|
| Rate for Payer: UHC Core |
$1,562.09
|
| Rate for Payer: UHC Exchange |
$1,178.32
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
IP
|
$2,998.26
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,888.90 |
| Max. Negotiated Rate |
$2,698.43 |
| Rate for Payer: Aetna Commercial |
$2,548.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,948.87
|
| Rate for Payer: Cash Price |
$2,398.61
|
| Rate for Payer: Cofinity Advantage |
$2,098.78
|
| Rate for Payer: Cofinity Commercial |
$2,578.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,398.61
|
| Rate for Payer: Healthscope Commercial |
$2,698.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,548.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,248.70
|
| Rate for Payer: PHP Commercial |
$2,548.52
|
| Rate for Payer: Priority Health SBD |
$1,888.90
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
IP
|
$3,331.45
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,098.81 |
| Max. Negotiated Rate |
$2,998.30 |
| Rate for Payer: Aetna Commercial |
$2,831.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,165.44
|
| Rate for Payer: Cash Price |
$2,665.16
|
| Rate for Payer: Cofinity Advantage |
$2,332.01
|
| Rate for Payer: Cofinity Commercial |
$2,865.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,665.16
|
| Rate for Payer: Healthscope Commercial |
$2,998.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,831.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,498.59
|
| Rate for Payer: PHP Commercial |
$2,831.73
|
| Rate for Payer: Priority Health SBD |
$2,098.81
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
OP
|
$3,331.45
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,309.26 |
| Max. Negotiated Rate |
$2,998.30 |
| Rate for Payer: Aetna Commercial |
$2,831.73
|
| Rate for Payer: Aetna Medicare |
$1,665.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,165.44
|
| Rate for Payer: BCBS Complete |
$1,332.58
|
| Rate for Payer: Cash Price |
$2,665.16
|
| Rate for Payer: Cofinity Advantage |
$2,332.01
|
| Rate for Payer: Cofinity Commercial |
$2,865.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,665.16
|
| Rate for Payer: Healthscope Commercial |
$2,998.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,665.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,831.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,498.59
|
| Rate for Payer: PHP Commercial |
$2,831.73
|
| Rate for Payer: Priority Health SBD |
$2,098.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,165.44
|
| Rate for Payer: UHC Core |
$1,735.69
|
| Rate for Payer: UHC Exchange |
$1,309.26
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
OP
|
$1,236.61
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$485.99 |
| Max. Negotiated Rate |
$1,112.95 |
| Rate for Payer: Aetna Commercial |
$1,051.12
|
| Rate for Payer: Aetna Medicare |
$618.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.80
|
| Rate for Payer: BCBS Complete |
$494.64
|
| Rate for Payer: Cash Price |
$989.29
|
| Rate for Payer: Cofinity Advantage |
$865.63
|
| Rate for Payer: Cofinity Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.29
|
| Rate for Payer: Healthscope Commercial |
$1,112.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$989.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.46
|
| Rate for Payer: PHP Commercial |
$1,051.12
|
| Rate for Payer: Priority Health SBD |
$779.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.80
|
| Rate for Payer: UHC Core |
$644.27
|
| Rate for Payer: UHC Exchange |
$485.99
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
IP
|
$1,236.61
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$779.06 |
| Max. Negotiated Rate |
$1,112.95 |
| Rate for Payer: Aetna Commercial |
$1,051.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.80
|
| Rate for Payer: Cash Price |
$989.29
|
| Rate for Payer: Cofinity Advantage |
$865.63
|
| Rate for Payer: Cofinity Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.29
|
| Rate for Payer: Healthscope Commercial |
$1,112.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.46
|
| Rate for Payer: PHP Commercial |
$1,051.12
|
| Rate for Payer: Priority Health SBD |
$779.06
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
OP
|
$1,484.78
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$583.52 |
| Max. Negotiated Rate |
$1,336.30 |
| Rate for Payer: Aetna Commercial |
$1,262.06
|
| Rate for Payer: Aetna Medicare |
$742.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$965.11
|
| Rate for Payer: BCBS Complete |
$593.91
|
| Rate for Payer: Cash Price |
$1,187.82
|
| Rate for Payer: Cofinity Advantage |
$1,039.35
|
| Rate for Payer: Cofinity Commercial |
$1,276.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.82
|
| Rate for Payer: Healthscope Commercial |
$1,336.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,113.59
|
| Rate for Payer: PHP Commercial |
$1,262.06
|
| Rate for Payer: Priority Health SBD |
$935.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$965.11
|
| Rate for Payer: UHC Core |
$773.57
|
| Rate for Payer: UHC Exchange |
$583.52
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
IP
|
$1,484.78
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$935.41 |
| Max. Negotiated Rate |
$1,336.30 |
| Rate for Payer: Aetna Commercial |
$1,262.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$965.11
|
| Rate for Payer: Cash Price |
$1,187.82
|
| Rate for Payer: Cofinity Advantage |
$1,039.35
|
| Rate for Payer: Cofinity Commercial |
$1,276.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.82
|
| Rate for Payer: Healthscope Commercial |
$1,336.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,113.59
|
| Rate for Payer: PHP Commercial |
$1,262.06
|
| Rate for Payer: Priority Health SBD |
$935.41
|
|
|
HC LEAD
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.14
|
| Rate for Payer: BCBS Complete |
$6.65
|
| Rate for Payer: BCBS MAPPO |
$12.11
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: BCN Medicare Advantage |
$12.11
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Advantage |
$32.05
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Mclaren Medicaid |
$6.33
|
| Rate for Payer: Mclaren Medicare |
$12.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.72
|
| Rate for Payer: Meridian Medicaid |
$12.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$18.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.34
|
| Rate for Payer: PACE Medicare |
$11.50
|
| Rate for Payer: PACE SWMI |
$12.11
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$12.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.11
|
| Rate for Payer: Priority Health Medicare |
$12.11
|
| Rate for Payer: Priority Health SBD |
$28.84
|
| Rate for Payer: Priority Health Tiered Network |
$9.69
|
| Rate for Payer: Railroad Medicare Medicare |
$12.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$18.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.11
|
| Rate for Payer: UHC Exchange |
$18.17
|
| Rate for Payer: UHC Medicaid |
$6.33
|
| Rate for Payer: UHCCP Medicaid |
$6.33
|
| Rate for Payer: VA VA |
$12.11
|
|
|
HC LEAD
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Advantage |
$32.05
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.34
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health SBD |
$28.84
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
IP
|
$15,033.78
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,471.28 |
| Max. Negotiated Rate |
$13,530.40 |
| Rate for Payer: Aetna Commercial |
$12,778.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,771.96
|
| Rate for Payer: Cash Price |
$12,027.02
|
| Rate for Payer: Cofinity Advantage |
$10,523.65
|
| Rate for Payer: Cofinity Commercial |
$12,929.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,027.02
|
| Rate for Payer: Healthscope Commercial |
$13,530.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,778.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,275.33
|
| Rate for Payer: PHP Commercial |
$12,778.71
|
| Rate for Payer: Priority Health SBD |
$9,471.28
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
OP
|
$15,033.78
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,908.28 |
| Max. Negotiated Rate |
$13,530.40 |
| Rate for Payer: Aetna Commercial |
$12,778.71
|
| Rate for Payer: Aetna Medicare |
$7,516.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,771.96
|
| Rate for Payer: BCBS Complete |
$6,013.51
|
| Rate for Payer: Cash Price |
$12,027.02
|
| Rate for Payer: Cofinity Advantage |
$10,523.65
|
| Rate for Payer: Cofinity Commercial |
$12,929.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,027.02
|
| Rate for Payer: Healthscope Commercial |
$13,530.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,027.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,778.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,275.33
|
| Rate for Payer: PHP Commercial |
$12,778.71
|
| Rate for Payer: Priority Health SBD |
$9,471.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,771.96
|
| Rate for Payer: UHC Core |
$7,832.60
|
| Rate for Payer: UHC Exchange |
$5,908.28
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
IP
|
$2,080.80
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.90 |
| Max. Negotiated Rate |
$1,872.72 |
| Rate for Payer: Aetna Commercial |
$1,768.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,352.52
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cofinity Advantage |
$1,456.56
|
| Rate for Payer: Cofinity Commercial |
$1,789.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,664.64
|
| Rate for Payer: Healthscope Commercial |
$1,872.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,768.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,560.60
|
| Rate for Payer: PHP Commercial |
$1,768.68
|
| Rate for Payer: Priority Health SBD |
$1,310.90
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
OP
|
$2,080.80
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$817.75 |
| Max. Negotiated Rate |
$1,872.72 |
| Rate for Payer: Aetna Commercial |
$1,768.68
|
| Rate for Payer: Aetna Medicare |
$1,040.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,352.52
|
| Rate for Payer: BCBS Complete |
$832.32
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cofinity Advantage |
$1,456.56
|
| Rate for Payer: Cofinity Commercial |
$1,789.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,664.64
|
| Rate for Payer: Healthscope Commercial |
$1,872.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,664.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,768.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,560.60
|
| Rate for Payer: PHP Commercial |
$1,768.68
|
| Rate for Payer: Priority Health SBD |
$1,310.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,352.52
|
| Rate for Payer: UHC Core |
$1,084.10
|
| Rate for Payer: UHC Exchange |
$817.75
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
IP
|
$7,965.30
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,018.14 |
| Max. Negotiated Rate |
$7,168.77 |
| Rate for Payer: Aetna Commercial |
$6,770.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,177.44
|
| Rate for Payer: Cash Price |
$6,372.24
|
| Rate for Payer: Cofinity Advantage |
$5,575.71
|
| Rate for Payer: Cofinity Commercial |
$6,850.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,372.24
|
| Rate for Payer: Healthscope Commercial |
$7,168.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,770.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,973.98
|
| Rate for Payer: PHP Commercial |
$6,770.51
|
| Rate for Payer: Priority Health SBD |
$5,018.14
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
OP
|
$7,965.30
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.36 |
| Max. Negotiated Rate |
$7,168.77 |
| Rate for Payer: Aetna Commercial |
$6,770.51
|
| Rate for Payer: Aetna Medicare |
$3,982.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,177.44
|
| Rate for Payer: BCBS Complete |
$3,186.12
|
| Rate for Payer: Cash Price |
$6,372.24
|
| Rate for Payer: Cofinity Advantage |
$5,575.71
|
| Rate for Payer: Cofinity Commercial |
$6,850.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,372.24
|
| Rate for Payer: Healthscope Commercial |
$7,168.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,372.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,770.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,973.98
|
| Rate for Payer: PHP Commercial |
$6,770.51
|
| Rate for Payer: Priority Health SBD |
$5,018.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,177.44
|
| Rate for Payer: UHC Core |
$4,149.92
|
| Rate for Payer: UHC Exchange |
$3,130.36
|
|
|
HC LEAD NOS LVL 1
|
Facility
|
OP
|
$198.90
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$179.01 |
| Rate for Payer: Aetna Commercial |
$169.06
|
| Rate for Payer: Aetna Medicare |
$99.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.28
|
| Rate for Payer: BCBS Complete |
$79.56
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$159.12
|
| Rate for Payer: Cash Price |
$159.12
|
| Rate for Payer: Cofinity Advantage |
$139.23
|
| Rate for Payer: Cofinity Commercial |
$171.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.12
|
| Rate for Payer: Healthscope Commercial |
$179.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.18
|
| Rate for Payer: PHP Commercial |
$169.06
|
| Rate for Payer: Priority Health SBD |
$125.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.28
|
| Rate for Payer: UHC Core |
$103.63
|
| Rate for Payer: UHC Exchange |
$78.17
|
|
