|
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 |
$1,469.74
|
| 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
|
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 |
$1,633.06
|
| 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 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 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
|
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 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 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: BCBS Trust/PPO |
$10.72
|
| Rate for Payer: BCN Commercial |
$10.72
|
| 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: Nomi Health Commercial |
$18.16
|
| 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 HMO/PPO/Tiered Network |
$12.46
|
| Rate for Payer: Priority Health Medicare |
$12.11
|
| Rate for Payer: Priority Health Narrow Network |
$9.97
|
| Rate for Payer: Priority Health SBD |
$28.27
|
| Rate for Payer: Railroad Medicare Medicare |
$12.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.53
|
| 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
|
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 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 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
|
OP
|
$7,809.12
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,123.65 |
| Max. Negotiated Rate |
$7,028.21 |
| Rate for Payer: Aetna Commercial |
$6,637.75
|
| Rate for Payer: Aetna Medicare |
$3,904.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,075.93
|
| Rate for Payer: BCBS Complete |
$3,123.65
|
| 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
|
|
|
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
|
|
|
HC LEAD NOS LVL 1
|
Facility
|
OP
|
$198.90
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$179.01 |
| Rate for Payer: Aetna Commercial |
$169.06
|
| Rate for Payer: Aetna Medicare |
$99.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.28
|
| Rate for Payer: BCBS Complete |
$79.56
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$159.12
|
| Rate for Payer: Cash Price |
$159.12
|
| Rate for Payer: Cofinity Commercial |
$139.23
|
| Rate for Payer: Cofinity Commercial |
$171.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.12
|
| Rate for Payer: Healthscope Commercial |
$179.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.06
|
| Rate for Payer: PHP Commercial |
$169.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.28
|
| Rate for Payer: Priority Health SBD |
$125.31
|
|
|
HC LEAD NOS LVL 1
|
Facility
|
IP
|
$198.90
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.31 |
| Max. Negotiated Rate |
$179.01 |
| Rate for Payer: Aetna Commercial |
$169.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.28
|
| Rate for Payer: Cash Price |
$159.12
|
| Rate for Payer: Cofinity Commercial |
$139.23
|
| Rate for Payer: Cofinity Commercial |
$171.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.12
|
| Rate for Payer: Healthscope Commercial |
$179.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.06
|
| Rate for Payer: PHP Commercial |
$169.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.28
|
| Rate for Payer: Priority Health SBD |
$125.31
|
|
|
HC LEAD REMOVAL DUAL
|
Facility
|
OP
|
$2,925.53
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
36100074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$668.96 |
| Max. Negotiated Rate |
$11,206.98 |
| Rate for Payer: Aetna Commercial |
$2,486.70
|
| Rate for Payer: Aetna Medicare |
$3,708.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,901.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,457.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,457.14
|
| Rate for Payer: BCBS Complete |
$2,006.78
|
| Rate for Payer: BCBS MAPPO |
$3,565.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,442.45
|
| Rate for Payer: BCN Commercial |
$1,442.45
|
| Rate for Payer: BCN Medicare Advantage |
$3,565.71
|
| Rate for Payer: Cash Price |
$2,340.42
|
| Rate for Payer: Cash Price |
$2,340.42
|
| Rate for Payer: Cash Price |
$2,340.42
|
| Rate for Payer: Cofinity Commercial |
$2,515.96
|
| Rate for Payer: Cofinity Commercial |
$2,047.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,047.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,340.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,565.71
|
| Rate for Payer: Healthscope Commercial |
$2,632.98
|
| Rate for Payer: Mclaren Medicaid |
$1,911.22
|
| Rate for Payer: Mclaren Medicare |
$3,565.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,744.00
|
| Rate for Payer: Meridian Medicaid |
$2,006.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,100.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,486.70
|
| Rate for Payer: Nomi Health Commercial |
$10,697.13
|
| Rate for Payer: PACE Medicare |
$3,387.42
|
| Rate for Payer: PACE SWMI |
$3,565.71
|
| Rate for Payer: PHP Commercial |
$2,486.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,565.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,911.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,901.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,206.98
|
| Rate for Payer: Priority Health Medicare |
$3,565.71
|
| Rate for Payer: Priority Health Narrow Network |
$8,965.58
|
| Rate for Payer: Priority Health SBD |
$1,843.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3,565.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$668.96
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,565.71
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,565.71
|
| Rate for Payer: UHCCP Medicaid |
$2,007.49
|
| Rate for Payer: VA VA |
$3,565.71
|
|
|
HC LEAD REMOVAL DUAL
|
Facility
|
IP
|
$2,925.53
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
36100074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,843.08 |
| Max. Negotiated Rate |
$2,632.98 |
| Rate for Payer: Aetna Commercial |
$2,486.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,901.59
|
| Rate for Payer: Cash Price |
$2,340.42
|
| Rate for Payer: Cofinity Commercial |
$2,047.87
|
| Rate for Payer: Cofinity Commercial |
$2,515.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,047.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,340.42
|
| Rate for Payer: Healthscope Commercial |
$2,632.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,486.70
|
| Rate for Payer: PHP Commercial |
$2,486.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,901.59
|
| Rate for Payer: Priority Health SBD |
$1,843.08
|
|
|
HC LEAD REMOVAL SINGLE
|
Facility
|
IP
|
$3,704.87
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
36100073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,334.07 |
| Max. Negotiated Rate |
$3,334.38 |
| Rate for Payer: Aetna Commercial |
$3,149.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,408.17
|
| Rate for Payer: Cash Price |
$2,963.90
|
| Rate for Payer: Cofinity Commercial |
$2,593.41
|
| Rate for Payer: Cofinity Commercial |
$3,186.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,593.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,963.90
|
| Rate for Payer: Healthscope Commercial |
$3,334.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,149.14
|
| Rate for Payer: PHP Commercial |
$3,149.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,408.17
|
| Rate for Payer: Priority Health SBD |
$2,334.07
|
|
|
HC LEAD REMOVAL SINGLE
|
Facility
|
OP
|
$3,704.87
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
36100073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.45 |
| Max. Negotiated Rate |
$11,206.98 |
| Rate for Payer: Aetna Commercial |
$3,149.14
|
| Rate for Payer: Aetna Medicare |
$3,708.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,408.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,457.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,457.14
|
| Rate for Payer: BCBS Complete |
$2,006.78
|
| Rate for Payer: BCBS MAPPO |
$3,565.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.38
|
| Rate for Payer: BCN Commercial |
$1,236.38
|
| Rate for Payer: BCN Medicare Advantage |
$3,565.71
|
| Rate for Payer: Cash Price |
$2,963.90
|
| Rate for Payer: Cash Price |
$2,963.90
|
| Rate for Payer: Cash Price |
$2,963.90
|
| Rate for Payer: Cofinity Commercial |
$3,186.19
|
| Rate for Payer: Cofinity Commercial |
$2,593.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,593.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,963.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,565.71
|
| Rate for Payer: Healthscope Commercial |
$3,334.38
|
| Rate for Payer: Mclaren Medicaid |
$1,911.22
|
| Rate for Payer: Mclaren Medicare |
$3,565.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,744.00
|
| Rate for Payer: Meridian Medicaid |
$2,006.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,100.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,149.14
|
| Rate for Payer: Nomi Health Commercial |
$10,697.13
|
| Rate for Payer: PACE Medicare |
$3,387.42
|
| Rate for Payer: PACE SWMI |
$3,565.71
|
| Rate for Payer: PHP Commercial |
$3,149.14
|
| Rate for Payer: PHP Medicare Advantage |
$3,565.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,911.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,408.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,206.98
|
| Rate for Payer: Priority Health Medicare |
$3,565.71
|
| Rate for Payer: Priority Health Narrow Network |
$8,965.58
|
| Rate for Payer: Priority Health SBD |
$2,334.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3,565.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$509.45
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,565.71
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,565.71
|
| Rate for Payer: UHCCP Medicaid |
$2,007.49
|
| Rate for Payer: VA VA |
$3,565.71
|
|
|
HC LECITHIN-SPHINGOMYELIN
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 83661
|
| Hospital Charge Code |
30100634
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$22.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.49
|
| Rate for Payer: BCBS Complete |
$12.38
|
| Rate for Payer: BCBS MAPPO |
$21.99
|
| Rate for Payer: BCBS Trust/PPO |
$19.46
|
| Rate for Payer: BCN Commercial |
$19.46
|
| Rate for Payer: BCN Medicare Advantage |
$21.99
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.99
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Mclaren Medicaid |
$11.79
|
| Rate for Payer: Mclaren Medicare |
$21.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.09
|
| Rate for Payer: Meridian Medicaid |
$12.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$32.98
|
| Rate for Payer: PACE Medicare |
$20.89
|
| Rate for Payer: PACE SWMI |
$21.99
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: PHP Medicare Advantage |
$21.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.62
|
| Rate for Payer: Priority Health Medicare |
$21.99
|
| Rate for Payer: Priority Health Narrow Network |
$18.10
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: Railroad Medicare Medicare |
$21.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.99
|
| Rate for Payer: UHC Medicare Advantage |
$21.99
|
| Rate for Payer: UHCCP Medicaid |
$12.38
|
| Rate for Payer: VA VA |
$21.99
|
|
|
HC LECITHIN-SPHINGOMYELIN
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 83661
|
| Hospital Charge Code |
30100634
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health SBD |
$61.05
|
|
