|
HC LAYR CLOS WND REST BODY <2.5 CM
|
Facility
|
OP
|
$498.64
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
76100228
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$423.84
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$428.83
|
| Rate for Payer: Cofinity Commercial |
$349.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$448.78
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$423.84
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$314.14
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC LAYR CLOS WND REST BODY <2.5 CM
|
Facility
|
IP
|
$498.64
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
76100228
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.14 |
| Max. Negotiated Rate |
$448.78 |
| Rate for Payer: Aetna Commercial |
$423.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.12
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$349.05
|
| Rate for Payer: Cofinity Commercial |
$428.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Healthscope Commercial |
$448.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: PHP Commercial |
$423.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: Priority Health SBD |
$314.14
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
OP
|
$11,013.34
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,681.38 |
| Max. Negotiated Rate |
$9,912.01 |
| Rate for Payer: Aetna Commercial |
$9,361.34
|
| Rate for Payer: Aetna Medicare |
$3,262.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,158.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,921.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,921.12
|
| Rate for Payer: BCBS Complete |
$1,765.45
|
| Rate for Payer: BCBS MAPPO |
$3,136.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,136.90
|
| Rate for Payer: Cash Price |
$8,810.67
|
| Rate for Payer: Cash Price |
$8,810.67
|
| Rate for Payer: Cofinity Commercial |
$9,471.47
|
| Rate for Payer: Cofinity Commercial |
$7,709.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,709.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,810.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,136.90
|
| Rate for Payer: Healthscope Commercial |
$9,912.01
|
| Rate for Payer: Mclaren Medicaid |
$1,681.38
|
| Rate for Payer: Mclaren Medicare |
$3,136.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,293.74
|
| Rate for Payer: Meridian Medicaid |
$1,765.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,607.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,361.34
|
| Rate for Payer: PACE Medicare |
$2,980.05
|
| Rate for Payer: PACE SWMI |
$3,136.90
|
| Rate for Payer: PHP Commercial |
$9,361.34
|
| Rate for Payer: PHP Medicare Advantage |
$3,136.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,681.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,158.67
|
| Rate for Payer: Priority Health Medicare |
$3,136.90
|
| Rate for Payer: Priority Health SBD |
$6,938.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,136.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,830.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,136.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,136.90
|
| Rate for Payer: UHCCP Medicaid |
$1,766.07
|
| Rate for Payer: VA VA |
$3,136.90
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
IP
|
$11,013.34
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,938.40 |
| Max. Negotiated Rate |
$9,912.01 |
| Rate for Payer: Aetna Commercial |
$9,361.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,158.67
|
| Rate for Payer: Cash Price |
$8,810.67
|
| Rate for Payer: Cofinity Commercial |
$7,709.34
|
| Rate for Payer: Cofinity Commercial |
$9,471.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,709.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,810.67
|
| Rate for Payer: Healthscope Commercial |
$9,912.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,361.34
|
| Rate for Payer: PHP Commercial |
$9,361.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,158.67
|
| Rate for Payer: Priority Health SBD |
$6,938.40
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
OP
|
$59.77
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$53.79 |
| Rate for Payer: Aetna Commercial |
$50.80
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.85
|
| 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 |
$5.91
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$47.82
|
| Rate for Payer: Cash Price |
$47.82
|
| Rate for Payer: Cofinity Commercial |
$51.40
|
| Rate for Payer: Cofinity Commercial |
$41.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$53.79
|
| Rate for Payer: Mclaren Medicaid |
$5.63
|
| 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 |
$5.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.80
|
| Rate for Payer: PACE Medicare |
$9.97
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$50.80
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.85
|
| Rate for Payer: Priority Health Medicare |
$10.50
|
| Rate for Payer: Priority Health SBD |
$37.66
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.50
|
| Rate for Payer: UHC Medicare Advantage |
$10.50
|
| Rate for Payer: UHCCP Medicaid |
$5.91
|
| Rate for Payer: VA VA |
$10.50
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
IP
|
$59.77
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$53.79 |
| Rate for Payer: Aetna Commercial |
$50.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.85
|
| Rate for Payer: Cash Price |
$47.82
|
| Rate for Payer: Cofinity Commercial |
$41.84
|
| Rate for Payer: Cofinity Commercial |
$51.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.82
|
| Rate for Payer: Healthscope Commercial |
$53.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.80
|
| Rate for Payer: PHP Commercial |
$50.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.85
|
| Rate for Payer: Priority Health SBD |
$37.66
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
OP
|
$1,469.87
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$587.95 |
| Max. Negotiated Rate |
$1,322.88 |
| Rate for Payer: Aetna Commercial |
$1,249.39
|
| Rate for Payer: Aetna Medicare |
$734.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$955.42
|
| Rate for Payer: BCBS Complete |
$587.95
|
| Rate for Payer: Cash Price |
$1,175.90
|
| Rate for Payer: Cofinity Commercial |
$1,028.91
|
| Rate for Payer: Cofinity Commercial |
$1,264.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,028.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.90
|
| Rate for Payer: Healthscope Commercial |
$1,322.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.39
|
| Rate for Payer: PHP Commercial |
$1,249.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.42
|
| Rate for Payer: Priority Health SBD |
$926.02
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
IP
|
$1,469.87
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$926.02 |
| Max. Negotiated Rate |
$1,322.88 |
| Rate for Payer: Aetna Commercial |
$1,249.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$955.42
|
| Rate for Payer: Cash Price |
$1,175.90
|
| Rate for Payer: Cofinity Commercial |
$1,028.91
|
| Rate for Payer: Cofinity Commercial |
$1,264.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,028.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.90
|
| Rate for Payer: Healthscope Commercial |
$1,322.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.39
|
| Rate for Payer: PHP Commercial |
$1,249.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.42
|
| Rate for Payer: Priority Health SBD |
$926.02
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
OP
|
$3,674.46
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,469.78 |
| Max. Negotiated Rate |
$3,307.01 |
| Rate for Payer: Aetna Commercial |
$3,123.29
|
| Rate for Payer: Aetna Medicare |
$1,837.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,388.40
|
| Rate for Payer: BCBS Complete |
$1,469.78
|
| Rate for Payer: Cash Price |
$2,939.57
|
| Rate for Payer: Cofinity Commercial |
$2,572.12
|
| Rate for Payer: Cofinity Commercial |
$3,160.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,572.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,939.57
|
| Rate for Payer: Healthscope Commercial |
$3,307.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,123.29
|
| Rate for Payer: PHP Commercial |
$3,123.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,388.40
|
| Rate for Payer: Priority Health SBD |
$2,314.91
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
IP
|
$3,674.46
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,314.91 |
| Max. Negotiated Rate |
$3,307.01 |
| Rate for Payer: Aetna Commercial |
$3,123.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,388.40
|
| Rate for Payer: Cash Price |
$2,939.57
|
| Rate for Payer: Cofinity Commercial |
$2,572.12
|
| Rate for Payer: Cofinity Commercial |
$3,160.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,572.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,939.57
|
| Rate for Payer: Healthscope Commercial |
$3,307.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,123.29
|
| Rate for Payer: PHP Commercial |
$3,123.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,388.40
|
| Rate for Payer: Priority Health SBD |
$2,314.91
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
OP
|
$2,939.47
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,175.79 |
| Max. Negotiated Rate |
$2,645.52 |
| Rate for Payer: Aetna Commercial |
$2,498.55
|
| Rate for Payer: Aetna Medicare |
$1,469.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,910.66
|
| Rate for Payer: BCBS Complete |
$1,175.79
|
| Rate for Payer: Cash Price |
$2,351.58
|
| Rate for Payer: Cofinity Commercial |
$2,057.63
|
| Rate for Payer: Cofinity Commercial |
$2,527.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,057.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,351.58
|
| Rate for Payer: Healthscope Commercial |
$2,645.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,498.55
|
| Rate for Payer: PHP Commercial |
$2,498.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,910.66
|
| Rate for Payer: Priority Health SBD |
$1,851.87
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
IP
|
$2,939.47
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,851.87 |
| Max. Negotiated Rate |
$2,645.52 |
| Rate for Payer: Aetna Commercial |
$2,498.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,910.66
|
| Rate for Payer: Cash Price |
$2,351.58
|
| Rate for Payer: Cofinity Commercial |
$2,057.63
|
| Rate for Payer: Cofinity Commercial |
$2,527.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,057.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,351.58
|
| Rate for Payer: Healthscope Commercial |
$2,645.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,498.55
|
| Rate for Payer: PHP Commercial |
$2,498.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,910.66
|
| Rate for Payer: Priority Health SBD |
$1,851.87
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
IP
|
$3,266.13
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,057.66 |
| Max. Negotiated Rate |
$2,939.52 |
| Rate for Payer: Aetna Commercial |
$2,776.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,122.98
|
| Rate for Payer: Cash Price |
$2,612.90
|
| Rate for Payer: Cofinity Commercial |
$2,286.29
|
| Rate for Payer: Cofinity Commercial |
$2,808.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,286.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,612.90
|
| Rate for Payer: Healthscope Commercial |
$2,939.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,776.21
|
| Rate for Payer: PHP Commercial |
$2,776.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,122.98
|
| Rate for Payer: Priority Health SBD |
$2,057.66
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
OP
|
$3,266.13
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,306.45 |
| Max. Negotiated Rate |
$2,939.52 |
| Rate for Payer: Aetna Commercial |
$2,776.21
|
| Rate for Payer: Aetna Medicare |
$1,633.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,122.98
|
| Rate for Payer: BCBS Complete |
$1,306.45
|
| Rate for Payer: Cash Price |
$2,612.90
|
| Rate for Payer: Cofinity Commercial |
$2,286.29
|
| Rate for Payer: Cofinity Commercial |
$2,808.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,286.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,612.90
|
| Rate for Payer: Healthscope Commercial |
$2,939.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,776.21
|
| Rate for Payer: PHP Commercial |
$2,776.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,122.98
|
| Rate for Payer: Priority Health SBD |
$2,057.66
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
IP
|
$1,212.36
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$763.79 |
| Max. Negotiated Rate |
$1,091.12 |
| Rate for Payer: Aetna Commercial |
$1,030.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.03
|
| Rate for Payer: Cash Price |
$969.89
|
| Rate for Payer: Cofinity Commercial |
$1,042.63
|
| Rate for Payer: Cofinity Commercial |
$848.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$848.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.89
|
| Rate for Payer: Healthscope Commercial |
$1,091.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.51
|
| Rate for Payer: PHP Commercial |
$1,030.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.03
|
| Rate for Payer: Priority Health SBD |
$763.79
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
OP
|
$1,212.36
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$484.94 |
| Max. Negotiated Rate |
$1,091.12 |
| Rate for Payer: Aetna Commercial |
$1,030.51
|
| Rate for Payer: Aetna Medicare |
$606.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.03
|
| Rate for Payer: BCBS Complete |
$484.94
|
| Rate for Payer: Cash Price |
$969.89
|
| Rate for Payer: Cofinity Commercial |
$1,042.63
|
| Rate for Payer: Cofinity Commercial |
$848.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$848.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.89
|
| Rate for Payer: Healthscope Commercial |
$1,091.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.51
|
| Rate for Payer: PHP Commercial |
$1,030.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.03
|
| Rate for Payer: Priority Health SBD |
$763.79
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
IP
|
$1,455.67
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$917.07 |
| Max. Negotiated Rate |
$1,310.10 |
| Rate for Payer: Aetna Commercial |
$1,237.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.19
|
| Rate for Payer: Cash Price |
$1,164.54
|
| Rate for Payer: Cofinity Commercial |
$1,018.97
|
| Rate for Payer: Cofinity Commercial |
$1,251.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,018.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,164.54
|
| Rate for Payer: Healthscope Commercial |
$1,310.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,237.32
|
| Rate for Payer: PHP Commercial |
$1,237.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$946.19
|
| Rate for Payer: Priority Health SBD |
$917.07
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
OP
|
$1,455.67
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$582.27 |
| Max. Negotiated Rate |
$1,310.10 |
| Rate for Payer: Aetna Commercial |
$1,237.32
|
| Rate for Payer: Aetna Medicare |
$727.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.19
|
| Rate for Payer: BCBS Complete |
$582.27
|
| Rate for Payer: Cash Price |
$1,164.54
|
| Rate for Payer: Cofinity Commercial |
$1,018.97
|
| Rate for Payer: Cofinity Commercial |
$1,251.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,018.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,164.54
|
| Rate for Payer: Healthscope Commercial |
$1,310.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,237.32
|
| Rate for Payer: PHP Commercial |
$1,237.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$946.19
|
| Rate for Payer: Priority Health SBD |
$917.07
|
|
|
HC LEAD
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.15
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.17
|
| Rate for Payer: Priority Health SBD |
$28.27
|
|
|
HC LEAD
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| 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 |
$6.82
|
| Rate for Payer: BCBS MAPPO |
$12.11
|
| Rate for Payer: BCN Medicare Advantage |
$12.11
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Mclaren Medicaid |
$6.49
|
| 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 |
$6.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.15
|
| Rate for Payer: PACE Medicare |
$11.50
|
| Rate for Payer: PACE SWMI |
$12.11
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: PHP Medicare Advantage |
$12.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.17
|
| Rate for Payer: Priority Health Medicare |
$12.11
|
| Rate for Payer: Priority Health SBD |
$28.27
|
| Rate for Payer: Railroad Medicare Medicare |
$12.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.11
|
| Rate for Payer: UHC Medicare Advantage |
$12.11
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
| Rate for Payer: VA VA |
$12.11
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
OP
|
$14,739.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,895.60 |
| Max. Negotiated Rate |
$13,265.10 |
| Rate for Payer: Aetna Commercial |
$12,528.15
|
| Rate for Payer: Aetna Medicare |
$7,369.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,580.35
|
| Rate for Payer: BCBS Complete |
$5,895.60
|
| Rate for Payer: Cash Price |
$11,791.20
|
| Rate for Payer: Cofinity Commercial |
$10,317.30
|
| Rate for Payer: Cofinity Commercial |
$12,675.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,791.20
|
| Rate for Payer: Healthscope Commercial |
$13,265.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,528.15
|
| Rate for Payer: PHP Commercial |
$12,528.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,580.35
|
| Rate for Payer: Priority Health SBD |
$9,285.57
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
IP
|
$14,739.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,285.57 |
| Max. Negotiated Rate |
$13,265.10 |
| Rate for Payer: Aetna Commercial |
$12,528.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,580.35
|
| Rate for Payer: Cash Price |
$11,791.20
|
| Rate for Payer: Cofinity Commercial |
$10,317.30
|
| Rate for Payer: Cofinity Commercial |
$12,675.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,791.20
|
| Rate for Payer: Healthscope Commercial |
$13,265.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,528.15
|
| Rate for Payer: PHP Commercial |
$12,528.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,580.35
|
| Rate for Payer: Priority Health SBD |
$9,285.57
|
|
|
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 Commercial |
$1,456.56
|
| Rate for Payer: Cofinity Commercial |
$1,789.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,456.56
|
| 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: PHP Commercial |
$1,768.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,352.52
|
| 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 |
$832.32 |
| 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 Commercial |
$1,456.56
|
| Rate for Payer: Cofinity Commercial |
$1,789.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,456.56
|
| 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: PHP Commercial |
$1,768.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,352.52
|
| Rate for Payer: Priority Health SBD |
$1,310.90
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
IP
|
$7,809.12
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,919.75 |
| Max. Negotiated Rate |
$7,028.21 |
| Rate for Payer: Aetna Commercial |
$6,637.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,075.93
|
| Rate for Payer: Cash Price |
$6,247.30
|
| Rate for Payer: Cofinity Commercial |
$5,466.38
|
| Rate for Payer: Cofinity Commercial |
$6,715.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,466.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,247.30
|
| Rate for Payer: Healthscope Commercial |
$7,028.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,637.75
|
| Rate for Payer: PHP Commercial |
$6,637.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,075.93
|
| Rate for Payer: Priority Health SBD |
$4,919.75
|
|
