|
HC REPLACE SINGLE CHAMBER ICD
|
Facility
|
IP
|
$17,530.81
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
36100357
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,044.41 |
| Max. Negotiated Rate |
$15,777.73 |
| Rate for Payer: Aetna Commercial |
$14,901.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,395.03
|
| Rate for Payer: Cash Price |
$14,024.65
|
| Rate for Payer: Cofinity Commercial |
$12,271.57
|
| Rate for Payer: Cofinity Commercial |
$15,076.50
|
| Rate for Payer: Healthscope Commercial |
$15,777.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,901.19
|
| Rate for Payer: PHP Commercial |
$14,901.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,271.57
|
| Rate for Payer: Priority Health SBD |
$11,044.41
|
|
|
HC REPLACE SINGLE CHAMBER ICD
|
Facility
|
OP
|
$17,530.81
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
36100357
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$359.86 |
| Max. Negotiated Rate |
$26,217.10 |
| Rate for Payer: Aetna Commercial |
$14,901.19
|
| Rate for Payer: Aetna Medicare |
$21,812.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,395.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,217.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,217.10
|
| Rate for Payer: BCBS Complete |
$12,047.28
|
| Rate for Payer: BCBS MAPPO |
$20,973.68
|
| Rate for Payer: BCBS Trust/PPO |
$15,939.81
|
| Rate for Payer: BCN Medicare Advantage |
$20,973.68
|
| Rate for Payer: Cash Price |
$14,024.65
|
| Rate for Payer: Cash Price |
$14,024.65
|
| Rate for Payer: Cofinity Commercial |
$15,076.50
|
| Rate for Payer: Cofinity Commercial |
$12,271.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,973.68
|
| Rate for Payer: Healthscope Commercial |
$15,777.73
|
| Rate for Payer: Mclaren Medicaid |
$11,472.60
|
| Rate for Payer: Mclaren Medicare |
$20,973.68
|
| Rate for Payer: Meridian Medicaid |
$12,047.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,022.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,119.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,901.19
|
| Rate for Payer: PACE Medicare |
$19,925.00
|
| Rate for Payer: PACE SWMI |
$20,973.68
|
| Rate for Payer: PHP Commercial |
$14,901.19
|
| Rate for Payer: PHP Medicare Advantage |
$20,973.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,472.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,271.57
|
| Rate for Payer: Priority Health Medicare |
$20,973.68
|
| Rate for Payer: Priority Health SBD |
$11,044.41
|
| Rate for Payer: Railroad Medicare Medicare |
$20,973.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.85
|
| Rate for Payer: UHC Core |
$15,010.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,973.68
|
| Rate for Payer: UHC Exchange |
$359.86
|
| Rate for Payer: UHC Medicare Advantage |
$21,602.89
|
| Rate for Payer: VA VA |
$20,973.68
|
|
|
HC REPLACE SINGLE CHAMBER PPM
|
Facility
|
OP
|
$11,942.23
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
36100354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.42 |
| Max. Negotiated Rate |
$25,402.85 |
| Rate for Payer: Aetna Commercial |
$10,150.90
|
| Rate for Payer: Aetna Medicare |
$7,861.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,762.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,449.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,449.24
|
| Rate for Payer: BCBS Complete |
$4,342.11
|
| Rate for Payer: BCBS MAPPO |
$7,559.39
|
| Rate for Payer: BCBS Trust/PPO |
$5,723.99
|
| Rate for Payer: BCN Medicare Advantage |
$7,559.39
|
| Rate for Payer: Cash Price |
$9,553.78
|
| Rate for Payer: Cash Price |
$9,553.78
|
| Rate for Payer: Cofinity Commercial |
$8,359.56
|
| Rate for Payer: Cofinity Commercial |
$10,270.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,559.39
|
| Rate for Payer: Healthscope Commercial |
$10,748.01
|
| Rate for Payer: Mclaren Medicaid |
$4,134.99
|
| Rate for Payer: Mclaren Medicare |
$7,559.39
|
| Rate for Payer: Meridian Medicaid |
$4,342.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,937.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,693.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,150.90
|
| Rate for Payer: PACE Medicare |
$7,181.42
|
| Rate for Payer: PACE SWMI |
$7,559.39
|
| Rate for Payer: PHP Commercial |
$10,150.90
|
| Rate for Payer: PHP Medicare Advantage |
$7,559.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,134.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,359.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,402.85
|
| Rate for Payer: Priority Health Medicare |
$7,559.39
|
| Rate for Payer: Priority Health Narrow Network |
$20,322.28
|
| Rate for Payer: Priority Health SBD |
$7,523.60
|
| Rate for Payer: Railroad Medicare Medicare |
$7,559.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.26
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,559.39
|
| Rate for Payer: UHC Exchange |
$328.42
|
| Rate for Payer: UHC Medicare Advantage |
$7,786.17
|
| Rate for Payer: VA VA |
$7,559.39
|
|
|
HC REPLACE SINGLE CHAMBER PPM
|
Facility
|
IP
|
$11,942.23
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
36100354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,523.60 |
| Max. Negotiated Rate |
$10,748.01 |
| Rate for Payer: Aetna Commercial |
$10,150.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,762.45
|
| Rate for Payer: Cash Price |
$9,553.78
|
| Rate for Payer: Cofinity Commercial |
$10,270.32
|
| Rate for Payer: Cofinity Commercial |
$8,359.56
|
| Rate for Payer: Healthscope Commercial |
$10,748.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,150.90
|
| Rate for Payer: PHP Commercial |
$10,150.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,359.56
|
| Rate for Payer: Priority Health SBD |
$7,523.60
|
|
|
HC REPLACE SQ ICD ONLY
|
Facility
|
OP
|
$35,520.57
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
36100551
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$359.86 |
| Max. Negotiated Rate |
$31,968.51 |
| Rate for Payer: Aetna Commercial |
$30,192.48
|
| Rate for Payer: Aetna Medicare |
$21,812.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23,088.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,217.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,217.10
|
| Rate for Payer: BCBS Complete |
$12,047.28
|
| Rate for Payer: BCBS MAPPO |
$20,973.68
|
| Rate for Payer: BCBS Trust/PPO |
$15,939.81
|
| Rate for Payer: BCN Medicare Advantage |
$20,973.68
|
| Rate for Payer: Cash Price |
$28,416.46
|
| Rate for Payer: Cash Price |
$28,416.46
|
| Rate for Payer: Cofinity Commercial |
$30,547.69
|
| Rate for Payer: Cofinity Commercial |
$24,864.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,973.68
|
| Rate for Payer: Healthscope Commercial |
$31,968.51
|
| Rate for Payer: Mclaren Medicaid |
$11,472.60
|
| Rate for Payer: Mclaren Medicare |
$20,973.68
|
| Rate for Payer: Meridian Medicaid |
$12,047.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,022.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,119.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30,192.48
|
| Rate for Payer: PACE Medicare |
$19,925.00
|
| Rate for Payer: PACE SWMI |
$20,973.68
|
| Rate for Payer: PHP Commercial |
$30,192.48
|
| Rate for Payer: PHP Medicare Advantage |
$20,973.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,472.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,864.40
|
| Rate for Payer: Priority Health Medicare |
$20,973.68
|
| Rate for Payer: Priority Health SBD |
$22,377.96
|
| Rate for Payer: Railroad Medicare Medicare |
$20,973.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.85
|
| Rate for Payer: UHC Core |
$15,010.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,973.68
|
| Rate for Payer: UHC Exchange |
$359.86
|
| Rate for Payer: UHC Medicare Advantage |
$21,602.89
|
| Rate for Payer: VA VA |
$20,973.68
|
|
|
HC REPLACE SQ ICD ONLY
|
Facility
|
IP
|
$35,520.57
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
36100551
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$22,377.96 |
| Max. Negotiated Rate |
$31,968.51 |
| Rate for Payer: Aetna Commercial |
$30,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23,088.37
|
| Rate for Payer: Cash Price |
$28,416.46
|
| Rate for Payer: Cofinity Commercial |
$24,864.40
|
| Rate for Payer: Cofinity Commercial |
$30,547.69
|
| Rate for Payer: Healthscope Commercial |
$31,968.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30,192.48
|
| Rate for Payer: PHP Commercial |
$30,192.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,864.40
|
| Rate for Payer: Priority Health SBD |
$22,377.96
|
|
|
HC REPOSITION CVAC
|
Facility
|
OP
|
$2,459.63
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
36100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.63 |
| Max. Negotiated Rate |
$4,461.38 |
| Rate for Payer: Aetna Commercial |
$2,090.69
|
| Rate for Payer: Aetna Medicare |
$1,482.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.30
|
| Rate for Payer: BCBS Complete |
$818.54
|
| Rate for Payer: BCBS MAPPO |
$1,425.04
|
| Rate for Payer: BCBS Trust/PPO |
$453.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.04
|
| Rate for Payer: Cash Price |
$1,967.70
|
| Rate for Payer: Cash Price |
$1,967.70
|
| Rate for Payer: Cofinity Commercial |
$1,721.74
|
| Rate for Payer: Cofinity Commercial |
$2,115.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.04
|
| Rate for Payer: Healthscope Commercial |
$2,213.67
|
| Rate for Payer: Mclaren Medicaid |
$779.50
|
| Rate for Payer: Mclaren Medicare |
$1,425.04
|
| Rate for Payer: Meridian Medicaid |
$818.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,496.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,090.69
|
| Rate for Payer: PACE Medicare |
$1,353.79
|
| Rate for Payer: PACE SWMI |
$1,425.04
|
| Rate for Payer: PHP Commercial |
$2,090.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,721.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,461.38
|
| Rate for Payer: Priority Health Medicare |
$1,425.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,569.10
|
| Rate for Payer: Priority Health SBD |
$1,549.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,425.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,425.04
|
| Rate for Payer: UHC Exchange |
$57.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,467.79
|
| Rate for Payer: VA VA |
$1,425.04
|
|
|
HC REPOSITION CVAC
|
Facility
|
IP
|
$2,459.63
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
36100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,549.57 |
| Max. Negotiated Rate |
$2,213.67 |
| Rate for Payer: Aetna Commercial |
$2,090.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.76
|
| Rate for Payer: Cash Price |
$1,967.70
|
| Rate for Payer: Cofinity Commercial |
$1,721.74
|
| Rate for Payer: Cofinity Commercial |
$2,115.28
|
| Rate for Payer: Healthscope Commercial |
$2,213.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,090.69
|
| Rate for Payer: PHP Commercial |
$2,090.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,721.74
|
| Rate for Payer: Priority Health SBD |
$1,549.57
|
|
|
HC REPOSITION RA/RV ELECTRODE
|
Facility
|
IP
|
$2,883.95
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
36100064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,816.89 |
| Max. Negotiated Rate |
$2,595.56 |
| Rate for Payer: Aetna Commercial |
$2,451.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,874.57
|
| Rate for Payer: Cash Price |
$2,307.16
|
| Rate for Payer: Cofinity Commercial |
$2,018.76
|
| Rate for Payer: Cofinity Commercial |
$2,480.20
|
| Rate for Payer: Healthscope Commercial |
$2,595.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,451.36
|
| Rate for Payer: PHP Commercial |
$2,451.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,018.76
|
| Rate for Payer: Priority Health SBD |
$1,816.89
|
|
|
HC REPOSITION RA/RV ELECTRODE
|
Facility
|
OP
|
$2,883.95
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
36100064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$300.26 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$2,451.36
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,874.57
|
| 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 |
$627.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$2,307.16
|
| Rate for Payer: Cash Price |
$2,307.16
|
| Rate for Payer: Cofinity Commercial |
$2,480.20
|
| Rate for Payer: Cofinity Commercial |
$2,018.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$2,595.56
|
| 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 |
$2,451.36
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$2,451.36
|
| 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 |
$2,018.76
|
| 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 |
$1,816.89
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.29
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$300.26
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC RESERVOIR 20 MICRON
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.00 |
| 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: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health SBD |
$66.15
|
|
|
HC RESERVOIR 20 MICRON
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
270
|
| 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: Healthscope Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health SBD |
$66.15
|
|
|
HC RESERVOIR OUTLET Y
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
27000668
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC RESERVOIR OUTLET Y
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
27000668
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC RESERVOIR TANDEM Y
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
27000667
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC RESERVOIR TANDEM Y
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
27000667
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC RESERVOIR VEN STAND ALONE
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
27000653
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$519.75 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna Commercial |
$701.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.25
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Cofinity Commercial |
$709.50
|
| Rate for Payer: Healthscope Commercial |
$742.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: PHP Commercial |
$701.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health SBD |
$519.75
|
|
|
HC RESERVOIR VEN STAND ALONE
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
27000653
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna Commercial |
$701.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.25
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Cofinity Commercial |
$709.50
|
| Rate for Payer: Healthscope Commercial |
$742.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: PHP Commercial |
$701.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health SBD |
$519.75
|
|
|
HC RESPIRATORY ALLERGEN PROFILE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200121
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC RESPIRATORY ALLERGEN PROFILE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200121
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC RESPIRATORY FLOW VOLUME
|
Facility
|
IP
|
$174.91
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
46000023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$110.19 |
| Max. Negotiated Rate |
$157.42 |
| Rate for Payer: Aetna Commercial |
$148.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.69
|
| Rate for Payer: Cash Price |
$139.93
|
| Rate for Payer: Cofinity Commercial |
$150.42
|
| Rate for Payer: Cofinity Commercial |
$122.44
|
| Rate for Payer: Healthscope Commercial |
$157.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.67
|
| Rate for Payer: PHP Commercial |
$148.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.44
|
| Rate for Payer: Priority Health SBD |
$110.19
|
|
|
HC RESPIRATORY FLOW VOLUME
|
Facility
|
OP
|
$174.91
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
46000023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$38.31 |
| Max. Negotiated Rate |
$349.11 |
| Rate for Payer: Aetna Commercial |
$148.67
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$110.53
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$139.93
|
| Rate for Payer: Cash Price |
$139.93
|
| Rate for Payer: Cofinity Commercial |
$150.42
|
| Rate for Payer: Cofinity Commercial |
$122.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$157.42
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.67
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$148.67
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.44
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$110.19
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$38.31
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC RESPIRATORY MOTION SIMULATION
|
Facility
|
OP
|
$2,541.00
|
|
|
Service Code
|
CPT 77293
|
| Hospital Charge Code |
33300058
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$401.12 |
| Max. Negotiated Rate |
$2,286.90 |
| Rate for Payer: Aetna Commercial |
$2,159.85
|
| Rate for Payer: Aetna Commercial |
$878.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,651.65
|
| Rate for Payer: BCBS Complete |
$1,016.40
|
| Rate for Payer: BCBS Complete |
$413.57
|
| Rate for Payer: BCBS Trust/PPO |
$509.68
|
| Rate for Payer: BCBS Trust/PPO |
$509.68
|
| Rate for Payer: Cash Price |
$2,032.80
|
| Rate for Payer: Cash Price |
$827.14
|
| Rate for Payer: Cash Price |
$827.14
|
| Rate for Payer: Cash Price |
$2,032.80
|
| Rate for Payer: Cofinity Commercial |
$2,185.26
|
| Rate for Payer: Cofinity Commercial |
$723.75
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Cofinity Commercial |
$1,778.70
|
| Rate for Payer: Healthscope Commercial |
$930.54
|
| Rate for Payer: Healthscope Commercial |
$2,286.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,159.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$878.84
|
| Rate for Payer: PHP Commercial |
$2,159.85
|
| Rate for Payer: PHP Commercial |
$878.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,778.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.75
|
| Rate for Payer: Priority Health SBD |
$651.38
|
| Rate for Payer: Priority Health SBD |
$1,600.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.23
|
| Rate for Payer: UHC Exchange |
$401.12
|
| Rate for Payer: UHC Exchange |
$401.12
|
|
|
HC RESPIRATORY MOTION SIMULATION
|
Facility
|
IP
|
$2,541.00
|
|
|
Service Code
|
CPT 77293
|
| Hospital Charge Code |
33300058
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,600.83 |
| Max. Negotiated Rate |
$2,286.90 |
| Rate for Payer: Aetna Commercial |
$2,159.85
|
| Rate for Payer: Aetna Commercial |
$878.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,651.65
|
| Rate for Payer: Cash Price |
$827.14
|
| Rate for Payer: Cash Price |
$2,032.80
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Cofinity Commercial |
$2,185.26
|
| Rate for Payer: Cofinity Commercial |
$1,778.70
|
| Rate for Payer: Cofinity Commercial |
$723.75
|
| Rate for Payer: Healthscope Commercial |
$930.54
|
| Rate for Payer: Healthscope Commercial |
$2,286.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$878.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,159.85
|
| Rate for Payer: PHP Commercial |
$878.84
|
| Rate for Payer: PHP Commercial |
$2,159.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,778.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.75
|
| Rate for Payer: Priority Health SBD |
$651.38
|
| Rate for Payer: Priority Health SBD |
$1,600.83
|
|
|
HC RESPIRATORY SYNCYTIAL VIRUS AG
|
Facility
|
IP
|
$99.60
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
30600175
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.75 |
| Max. Negotiated Rate |
$89.64 |
| Rate for Payer: Aetna Commercial |
$84.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.74
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Cofinity Commercial |
$69.72
|
| Rate for Payer: Cofinity Commercial |
$85.66
|
| Rate for Payer: Healthscope Commercial |
$89.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.66
|
| Rate for Payer: PHP Commercial |
$84.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.72
|
| Rate for Payer: Priority Health SBD |
$62.75
|
|
