|
HC INTRA ART ADMIN RP PARTICULATE
|
Facility
|
IP
|
$1,073.12
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
34200001
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$676.07 |
| Max. Negotiated Rate |
$965.81 |
| Rate for Payer: Aetna Commercial |
$912.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.53
|
| Rate for Payer: Cash Price |
$858.50
|
| Rate for Payer: Cofinity Commercial |
$751.18
|
| Rate for Payer: Cofinity Commercial |
$922.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$751.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.50
|
| Rate for Payer: Healthscope Commercial |
$965.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.15
|
| Rate for Payer: PHP Commercial |
$912.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.53
|
| Rate for Payer: Priority Health SBD |
$676.07
|
|
|
HC INTRA ATRIAL PACING
|
Facility
|
OP
|
$3,148.49
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
48100033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,983.55 |
| Max. Negotiated Rate |
$23,367.06 |
| Rate for Payer: Aetna Commercial |
$2,676.22
|
| Rate for Payer: Aetna Medicare |
$7,732.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,046.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,293.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,293.34
|
| Rate for Payer: BCBS Complete |
$4,184.23
|
| Rate for Payer: BCBS MAPPO |
$7,434.67
|
| Rate for Payer: BCBS Trust/PPO |
$19,728.06
|
| Rate for Payer: BCN Commercial |
$19,728.06
|
| Rate for Payer: BCN Medicare Advantage |
$7,434.67
|
| Rate for Payer: Cash Price |
$2,518.79
|
| Rate for Payer: Cash Price |
$2,518.79
|
| Rate for Payer: Cash Price |
$2,518.79
|
| Rate for Payer: Cofinity Commercial |
$2,203.94
|
| Rate for Payer: Cofinity Commercial |
$2,707.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,203.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,518.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,434.67
|
| Rate for Payer: Healthscope Commercial |
$2,833.64
|
| Rate for Payer: Mclaren Medicaid |
$3,984.98
|
| Rate for Payer: Mclaren Medicare |
$7,434.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,806.40
|
| Rate for Payer: Meridian Medicaid |
$4,184.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,549.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,676.22
|
| Rate for Payer: Nomi Health Commercial |
$15,612.81
|
| Rate for Payer: PACE Medicare |
$7,062.94
|
| Rate for Payer: PACE SWMI |
$7,434.67
|
| Rate for Payer: PHP Commercial |
$2,676.22
|
| Rate for Payer: PHP Medicare Advantage |
$7,434.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,984.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,046.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,367.06
|
| Rate for Payer: Priority Health Medicare |
$7,434.67
|
| Rate for Payer: Priority Health Narrow Network |
$18,693.65
|
| Rate for Payer: Priority Health SBD |
$1,983.55
|
| Rate for Payer: Railroad Medicare Medicare |
$7,434.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,927.85
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,434.67
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,434.67
|
| Rate for Payer: UHCCP Medicaid |
$4,185.72
|
| Rate for Payer: VA VA |
$7,434.67
|
|
|
HC INTRA ATRIAL PACING
|
Facility
|
IP
|
$3,148.49
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
48100033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,983.55 |
| Max. Negotiated Rate |
$2,833.64 |
| Rate for Payer: Aetna Commercial |
$2,676.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,046.52
|
| Rate for Payer: Cash Price |
$2,518.79
|
| Rate for Payer: Cofinity Commercial |
$2,203.94
|
| Rate for Payer: Cofinity Commercial |
$2,707.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,203.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,518.79
|
| Rate for Payer: Healthscope Commercial |
$2,833.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,676.22
|
| Rate for Payer: PHP Commercial |
$2,676.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,046.52
|
| Rate for Payer: Priority Health SBD |
$1,983.55
|
|
|
HC INTRA ATRIAL RECORDING
|
Facility
|
OP
|
$3,037.97
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
48100030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,913.92 |
| Max. Negotiated Rate |
$23,367.06 |
| Rate for Payer: Aetna Commercial |
$2,582.27
|
| Rate for Payer: Aetna Medicare |
$7,732.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,974.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,293.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,293.34
|
| Rate for Payer: BCBS Complete |
$4,184.23
|
| Rate for Payer: BCBS MAPPO |
$7,434.67
|
| Rate for Payer: BCBS Trust/PPO |
$19,728.06
|
| Rate for Payer: BCN Commercial |
$19,728.06
|
| Rate for Payer: BCN Medicare Advantage |
$7,434.67
|
| Rate for Payer: Cash Price |
$2,430.38
|
| Rate for Payer: Cash Price |
$2,430.38
|
| Rate for Payer: Cash Price |
$2,430.38
|
| Rate for Payer: Cofinity Commercial |
$2,126.58
|
| Rate for Payer: Cofinity Commercial |
$2,612.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,126.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,434.67
|
| Rate for Payer: Healthscope Commercial |
$2,734.17
|
| Rate for Payer: Mclaren Medicaid |
$3,984.98
|
| Rate for Payer: Mclaren Medicare |
$7,434.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,806.40
|
| Rate for Payer: Meridian Medicaid |
$4,184.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,549.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,582.27
|
| Rate for Payer: Nomi Health Commercial |
$15,612.81
|
| Rate for Payer: PACE Medicare |
$7,062.94
|
| Rate for Payer: PACE SWMI |
$7,434.67
|
| Rate for Payer: PHP Commercial |
$2,582.27
|
| Rate for Payer: PHP Medicare Advantage |
$7,434.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,984.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,974.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,367.06
|
| Rate for Payer: Priority Health Medicare |
$7,434.67
|
| Rate for Payer: Priority Health Narrow Network |
$18,693.65
|
| Rate for Payer: Priority Health SBD |
$1,913.92
|
| Rate for Payer: Railroad Medicare Medicare |
$7,434.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,927.85
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,434.67
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,434.67
|
| Rate for Payer: UHCCP Medicaid |
$4,185.72
|
| Rate for Payer: VA VA |
$7,434.67
|
|
|
HC INTRA ATRIAL RECORDING
|
Facility
|
IP
|
$3,037.97
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
48100030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,913.92 |
| Max. Negotiated Rate |
$2,734.17 |
| Rate for Payer: Aetna Commercial |
$2,582.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,974.68
|
| Rate for Payer: Cash Price |
$2,430.38
|
| Rate for Payer: Cofinity Commercial |
$2,126.58
|
| Rate for Payer: Cofinity Commercial |
$2,612.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,126.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.38
|
| Rate for Payer: Healthscope Commercial |
$2,734.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,582.27
|
| Rate for Payer: PHP Commercial |
$2,582.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,974.68
|
| Rate for Payer: Priority Health SBD |
$1,913.92
|
|
|
HC INTRACARDIAC ECHOCARDIOGRAPHY
|
Facility
|
IP
|
$5,511.38
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
48100047
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,472.17 |
| Max. Negotiated Rate |
$4,960.24 |
| Rate for Payer: Aetna Commercial |
$4,684.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,582.40
|
| Rate for Payer: Cash Price |
$4,409.10
|
| Rate for Payer: Cofinity Commercial |
$3,857.97
|
| Rate for Payer: Cofinity Commercial |
$4,739.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,857.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,409.10
|
| Rate for Payer: Healthscope Commercial |
$4,960.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,684.67
|
| Rate for Payer: PHP Commercial |
$4,684.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,582.40
|
| Rate for Payer: Priority Health SBD |
$3,472.17
|
|
|
HC INTRACARDIAC ECHOCARDIOGRAPHY
|
Facility
|
OP
|
$5,511.38
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
48100047
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$302.70 |
| Max. Negotiated Rate |
$4,960.24 |
| Rate for Payer: Aetna Commercial |
$4,684.67
|
| Rate for Payer: Aetna Medicare |
$2,755.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,582.40
|
| Rate for Payer: BCBS Complete |
$2,204.55
|
| Rate for Payer: BCBS Trust/PPO |
$302.70
|
| Rate for Payer: BCN Commercial |
$302.70
|
| Rate for Payer: Cash Price |
$4,409.10
|
| Rate for Payer: Cash Price |
$4,409.10
|
| Rate for Payer: Cash Price |
$4,409.10
|
| Rate for Payer: Cofinity Commercial |
$3,857.97
|
| Rate for Payer: Cofinity Commercial |
$4,739.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,857.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,409.10
|
| Rate for Payer: Healthscope Commercial |
$4,960.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,684.67
|
| Rate for Payer: PHP Commercial |
$4,684.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,582.40
|
| Rate for Payer: Priority Health SBD |
$3,472.17
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INTRACARDIAC ELECTROCARDIOGRAPHY CATH LVL 55
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1759
|
| Hospital Charge Code |
27200379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$4,950.00 |
| Rate for Payer: Aetna Commercial |
$4,675.00
|
| Rate for Payer: Aetna Medicare |
$2,750.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,575.00
|
| Rate for Payer: BCBS Complete |
$2,200.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Cofinity Commercial |
$3,850.00
|
| Rate for Payer: Cofinity Commercial |
$4,730.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,850.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,400.00
|
| Rate for Payer: Healthscope Commercial |
$4,950.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,675.00
|
| Rate for Payer: PHP Commercial |
$4,675.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,575.00
|
| Rate for Payer: Priority Health SBD |
$3,465.00
|
|
|
HC INTRACARDIAC ELECTROCARDIOGRAPHY CATH LVL 55
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1759
|
| Hospital Charge Code |
27200379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,465.00 |
| Max. Negotiated Rate |
$4,950.00 |
| Rate for Payer: Aetna Commercial |
$4,675.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,575.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Cofinity Commercial |
$3,850.00
|
| Rate for Payer: Cofinity Commercial |
$4,730.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,850.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,400.00
|
| Rate for Payer: Healthscope Commercial |
$4,950.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,675.00
|
| Rate for Payer: PHP Commercial |
$4,675.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,575.00
|
| Rate for Payer: Priority Health SBD |
$3,465.00
|
|
|
HC INTRACAV APPL - I
|
Facility
|
OP
|
$573.26
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$303.79 |
| Max. Negotiated Rate |
$1,781.38 |
| Rate for Payer: Aetna Commercial |
$487.27
|
| Rate for Payer: Aetna Medicare |
$589.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$708.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$708.46
|
| Rate for Payer: BCBS Complete |
$318.98
|
| Rate for Payer: BCBS MAPPO |
$566.77
|
| Rate for Payer: BCBS Trust/PPO |
$478.39
|
| Rate for Payer: BCN Commercial |
$478.39
|
| Rate for Payer: BCN Medicare Advantage |
$566.77
|
| Rate for Payer: Cash Price |
$458.61
|
| Rate for Payer: Cash Price |
$458.61
|
| Rate for Payer: Cofinity Commercial |
$493.00
|
| Rate for Payer: Cofinity Commercial |
$401.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$401.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$566.77
|
| Rate for Payer: Healthscope Commercial |
$515.93
|
| Rate for Payer: Mclaren Medicaid |
$303.79
|
| Rate for Payer: Mclaren Medicare |
$566.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$595.11
|
| Rate for Payer: Meridian Medicaid |
$318.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$651.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.27
|
| Rate for Payer: Nomi Health Commercial |
$1,700.31
|
| Rate for Payer: PACE Medicare |
$538.43
|
| Rate for Payer: PACE SWMI |
$566.77
|
| Rate for Payer: PHP Commercial |
$487.27
|
| Rate for Payer: PHP Medicare Advantage |
$566.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$303.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,781.38
|
| Rate for Payer: Priority Health Medicare |
$566.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,425.10
|
| Rate for Payer: Priority Health SBD |
$361.15
|
| Rate for Payer: Railroad Medicare Medicare |
$566.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$566.77
|
| Rate for Payer: UHC Exchange |
$424.21
|
| Rate for Payer: UHC Medicare Advantage |
$566.77
|
| Rate for Payer: UHCCP Medicaid |
$319.09
|
| Rate for Payer: VA VA |
$566.77
|
|
|
HC INTRACAV APPL - I
|
Facility
|
IP
|
$573.26
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$361.15 |
| Max. Negotiated Rate |
$515.93 |
| Rate for Payer: Aetna Commercial |
$487.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.62
|
| Rate for Payer: Cash Price |
$458.61
|
| Rate for Payer: Cofinity Commercial |
$401.28
|
| Rate for Payer: Cofinity Commercial |
$493.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$401.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.61
|
| Rate for Payer: Healthscope Commercial |
$515.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.27
|
| Rate for Payer: PHP Commercial |
$487.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.62
|
| Rate for Payer: Priority Health SBD |
$361.15
|
|
|
HC INTRACAV APPL - S
|
Facility
|
OP
|
$436.97
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
33300027
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$275.29 |
| Max. Negotiated Rate |
$1,781.38 |
| Rate for Payer: Aetna Commercial |
$371.42
|
| Rate for Payer: Aetna Medicare |
$589.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$708.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$708.46
|
| Rate for Payer: BCBS Complete |
$318.98
|
| Rate for Payer: BCBS MAPPO |
$566.77
|
| Rate for Payer: BCBS Trust/PPO |
$416.78
|
| Rate for Payer: BCN Commercial |
$416.78
|
| Rate for Payer: BCN Medicare Advantage |
$566.77
|
| Rate for Payer: Cash Price |
$349.58
|
| Rate for Payer: Cash Price |
$349.58
|
| Rate for Payer: Cofinity Commercial |
$375.79
|
| Rate for Payer: Cofinity Commercial |
$305.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$566.77
|
| Rate for Payer: Healthscope Commercial |
$393.27
|
| Rate for Payer: Mclaren Medicaid |
$303.79
|
| Rate for Payer: Mclaren Medicare |
$566.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$595.11
|
| Rate for Payer: Meridian Medicaid |
$318.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$651.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.42
|
| Rate for Payer: Nomi Health Commercial |
$1,700.31
|
| Rate for Payer: PACE Medicare |
$538.43
|
| Rate for Payer: PACE SWMI |
$566.77
|
| Rate for Payer: PHP Commercial |
$371.42
|
| Rate for Payer: PHP Medicare Advantage |
$566.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$303.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,781.38
|
| Rate for Payer: Priority Health Medicare |
$566.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,425.10
|
| Rate for Payer: Priority Health SBD |
$275.29
|
| Rate for Payer: Railroad Medicare Medicare |
$566.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$566.77
|
| Rate for Payer: UHC Exchange |
$323.36
|
| Rate for Payer: UHC Medicare Advantage |
$566.77
|
| Rate for Payer: UHCCP Medicaid |
$319.09
|
| Rate for Payer: VA VA |
$566.77
|
|
|
HC INTRACAV APPL - S
|
Facility
|
IP
|
$436.97
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
33300027
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$275.29 |
| Max. Negotiated Rate |
$393.27 |
| Rate for Payer: Aetna Commercial |
$371.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.03
|
| Rate for Payer: Cash Price |
$349.58
|
| Rate for Payer: Cofinity Commercial |
$305.88
|
| Rate for Payer: Cofinity Commercial |
$375.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.58
|
| Rate for Payer: Healthscope Commercial |
$393.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.42
|
| Rate for Payer: PHP Commercial |
$371.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.03
|
| Rate for Payer: Priority Health SBD |
$275.29
|
|
|
HC INTRAOSSEOUS NEEDLE PLACEMENT
|
Facility
|
OP
|
$484.89
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$1,228.82 |
| Rate for Payer: Aetna Commercial |
$412.16
|
| Rate for Payer: Aetna Medicare |
$406.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$141.31
|
| Rate for Payer: BCN Commercial |
$141.31
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Cash Price |
$387.91
|
| Rate for Payer: Cash Price |
$387.91
|
| Rate for Payer: Cash Price |
$387.91
|
| Rate for Payer: Cofinity Commercial |
$339.42
|
| Rate for Payer: Cofinity Commercial |
$417.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Healthscope Commercial |
$436.40
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.16
|
| Rate for Payer: Nomi Health Commercial |
$1,172.91
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Commercial |
$412.16
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.82
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$983.06
|
| Rate for Payer: Priority Health SBD |
$305.48
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.00
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$220.12
|
| Rate for Payer: VA VA |
$390.97
|
|
|
HC INTRAOSSEOUS NEEDLE PLACEMENT
|
Facility
|
IP
|
$484.89
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.48 |
| Max. Negotiated Rate |
$436.40 |
| Rate for Payer: Aetna Commercial |
$412.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.18
|
| Rate for Payer: Cash Price |
$387.91
|
| Rate for Payer: Cofinity Commercial |
$339.42
|
| Rate for Payer: Cofinity Commercial |
$417.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.91
|
| Rate for Payer: Healthscope Commercial |
$436.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.16
|
| Rate for Payer: PHP Commercial |
$412.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.18
|
| Rate for Payer: Priority Health SBD |
$305.48
|
|
|
HC INTRASPINAL CATHETER
|
Facility
|
OP
|
$292.74
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
27200248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.10 |
| Max. Negotiated Rate |
$263.47 |
| Rate for Payer: Aetna Commercial |
$248.83
|
| Rate for Payer: Aetna Medicare |
$146.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.28
|
| Rate for Payer: BCBS Complete |
$117.10
|
| Rate for Payer: Cash Price |
$234.19
|
| Rate for Payer: Cofinity Commercial |
$204.92
|
| Rate for Payer: Cofinity Commercial |
$251.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.19
|
| Rate for Payer: Healthscope Commercial |
$263.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.83
|
| Rate for Payer: PHP Commercial |
$248.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.28
|
| Rate for Payer: Priority Health SBD |
$184.43
|
|
|
HC INTRASPINAL CATHETER
|
Facility
|
IP
|
$292.74
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
27200248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.43 |
| Max. Negotiated Rate |
$263.47 |
| Rate for Payer: Aetna Commercial |
$248.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.28
|
| Rate for Payer: Cash Price |
$234.19
|
| Rate for Payer: Cofinity Commercial |
$204.92
|
| Rate for Payer: Cofinity Commercial |
$251.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.19
|
| Rate for Payer: Healthscope Commercial |
$263.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.83
|
| Rate for Payer: PHP Commercial |
$248.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.28
|
| Rate for Payer: Priority Health SBD |
$184.43
|
|
|
HC INTRAUTERINE COPPER CONTRACEPTIVE
|
Facility
|
IP
|
$1,765.44
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
63600119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,112.23 |
| Max. Negotiated Rate |
$1,588.90 |
| Rate for Payer: Aetna Commercial |
$1,500.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,147.54
|
| Rate for Payer: Cash Price |
$1,412.35
|
| Rate for Payer: Cofinity Commercial |
$1,235.81
|
| Rate for Payer: Cofinity Commercial |
$1,518.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,235.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,412.35
|
| Rate for Payer: Healthscope Commercial |
$1,588.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,500.62
|
| Rate for Payer: PHP Commercial |
$1,500.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.54
|
| Rate for Payer: Priority Health SBD |
$1,112.23
|
|
|
HC INTRAUTERINE COPPER CONTRACEPTIVE
|
Facility
|
OP
|
$1,765.44
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
63600119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$706.18 |
| Max. Negotiated Rate |
$3,190.73 |
| Rate for Payer: Aetna Commercial |
$1,500.62
|
| Rate for Payer: Aetna Medicare |
$882.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,147.54
|
| Rate for Payer: BCBS Complete |
$706.18
|
| Rate for Payer: BCBS Trust/PPO |
$3,190.73
|
| Rate for Payer: BCN Commercial |
$3,190.73
|
| Rate for Payer: Cash Price |
$1,412.35
|
| Rate for Payer: Cash Price |
$1,412.35
|
| Rate for Payer: Cofinity Commercial |
$1,518.28
|
| Rate for Payer: Cofinity Commercial |
$1,235.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,235.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,412.35
|
| Rate for Payer: Healthscope Commercial |
$1,588.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,500.62
|
| Rate for Payer: PHP Commercial |
$1,500.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.10
|
| Rate for Payer: Priority Health Narrow Network |
$920.08
|
| Rate for Payer: Priority Health SBD |
$1,112.23
|
|
|
HC INTRAVENTRICULAR PACING
|
Facility
|
OP
|
$3,767.24
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
48100034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,373.36 |
| Max. Negotiated Rate |
$23,367.06 |
| Rate for Payer: Aetna Commercial |
$3,202.15
|
| Rate for Payer: Aetna Medicare |
$7,732.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,448.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,293.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,293.34
|
| Rate for Payer: BCBS Complete |
$4,184.23
|
| Rate for Payer: BCBS MAPPO |
$7,434.67
|
| Rate for Payer: BCBS Trust/PPO |
$19,728.06
|
| Rate for Payer: BCN Commercial |
$19,728.06
|
| Rate for Payer: BCN Medicare Advantage |
$7,434.67
|
| Rate for Payer: Cash Price |
$3,013.79
|
| Rate for Payer: Cash Price |
$3,013.79
|
| Rate for Payer: Cash Price |
$3,013.79
|
| Rate for Payer: Cofinity Commercial |
$2,637.07
|
| Rate for Payer: Cofinity Commercial |
$3,239.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,637.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,434.67
|
| Rate for Payer: Healthscope Commercial |
$3,390.52
|
| Rate for Payer: Mclaren Medicaid |
$3,984.98
|
| Rate for Payer: Mclaren Medicare |
$7,434.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,806.40
|
| Rate for Payer: Meridian Medicaid |
$4,184.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,549.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.15
|
| Rate for Payer: Nomi Health Commercial |
$15,612.81
|
| Rate for Payer: PACE Medicare |
$7,062.94
|
| Rate for Payer: PACE SWMI |
$7,434.67
|
| Rate for Payer: PHP Commercial |
$3,202.15
|
| Rate for Payer: PHP Medicare Advantage |
$7,434.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,984.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,448.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,367.06
|
| Rate for Payer: Priority Health Medicare |
$7,434.67
|
| Rate for Payer: Priority Health Narrow Network |
$18,693.65
|
| Rate for Payer: Priority Health SBD |
$2,373.36
|
| Rate for Payer: Railroad Medicare Medicare |
$7,434.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,927.85
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,434.67
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,434.67
|
| Rate for Payer: UHCCP Medicaid |
$4,185.72
|
| Rate for Payer: VA VA |
$7,434.67
|
|
|
HC INTRAVENTRICULAR PACING
|
Facility
|
IP
|
$3,767.24
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
48100034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,373.36 |
| Max. Negotiated Rate |
$3,390.52 |
| Rate for Payer: Aetna Commercial |
$3,202.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,448.71
|
| Rate for Payer: Cash Price |
$3,013.79
|
| Rate for Payer: Cofinity Commercial |
$2,637.07
|
| Rate for Payer: Cofinity Commercial |
$3,239.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,637.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.79
|
| Rate for Payer: Healthscope Commercial |
$3,390.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.15
|
| Rate for Payer: PHP Commercial |
$3,202.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,448.71
|
| Rate for Payer: Priority Health SBD |
$2,373.36
|
|
|
HC INTRINSIC FACTOR ANTIBODIES
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
30200200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$13.35
|
| Rate for Payer: BCN Commercial |
$13.35
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$8.08
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: Nomi Health Commercial |
$22.62
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.51
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$12.41
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.08
|
| Rate for Payer: UHC Medicare Advantage |
$15.08
|
| Rate for Payer: UHCCP Medicaid |
$8.49
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC INTRINSIC FACTOR ANTIBODIES
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
30200200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.84 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: Priority Health SBD |
$30.84
|
|
|
HC INTRO AORTA TRANSLUMBAR
|
Facility
|
IP
|
$3,745.44
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
36100621
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,359.63 |
| Max. Negotiated Rate |
$3,370.90 |
| Rate for Payer: Aetna Commercial |
$3,183.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,434.54
|
| Rate for Payer: Cash Price |
$2,996.35
|
| Rate for Payer: Cofinity Commercial |
$2,621.81
|
| Rate for Payer: Cofinity Commercial |
$3,221.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,621.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,996.35
|
| Rate for Payer: Healthscope Commercial |
$3,370.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,183.62
|
| Rate for Payer: PHP Commercial |
$3,183.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,434.54
|
| Rate for Payer: Priority Health SBD |
$2,359.63
|
|
|
HC INTRO AORTA TRANSLUMBAR
|
Facility
|
OP
|
$3,745.44
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
36100621
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$129.18 |
| Max. Negotiated Rate |
$3,370.90 |
| Rate for Payer: Aetna Commercial |
$3,183.62
|
| Rate for Payer: Aetna Medicare |
$1,872.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,434.54
|
| Rate for Payer: BCBS Complete |
$1,498.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,010.09
|
| Rate for Payer: BCN Commercial |
$1,010.09
|
| Rate for Payer: Cash Price |
$2,996.35
|
| Rate for Payer: Cash Price |
$2,996.35
|
| Rate for Payer: Cash Price |
$2,996.35
|
| Rate for Payer: Cofinity Commercial |
$2,621.81
|
| Rate for Payer: Cofinity Commercial |
$3,221.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,621.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,996.35
|
| Rate for Payer: Healthscope Commercial |
$3,370.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,183.62
|
| Rate for Payer: PHP Commercial |
$3,183.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,434.54
|
| Rate for Payer: Priority Health SBD |
$2,359.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.18
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
