|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
OP
|
$9,233.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,628.58 |
| Max. Negotiated Rate |
$8,309.74 |
| Rate for Payer: Aetna Commercial |
$7,848.08
|
| Rate for Payer: Aetna Medicare |
$4,616.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,001.48
|
| Rate for Payer: BCBS Complete |
$3,693.22
|
| Rate for Payer: Cash Price |
$7,386.43
|
| Rate for Payer: Cofinity Advantage |
$6,463.13
|
| Rate for Payer: Cofinity Commercial |
$7,940.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,386.43
|
| Rate for Payer: Healthscope Commercial |
$8,309.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,386.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,848.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,924.78
|
| Rate for Payer: PHP Commercial |
$7,848.08
|
| Rate for Payer: Priority Health SBD |
$5,816.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,001.48
|
| Rate for Payer: UHC Core |
$4,810.41
|
| Rate for Payer: UHC Exchange |
$3,628.58
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
IP
|
$9,233.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,816.82 |
| Max. Negotiated Rate |
$8,309.74 |
| Rate for Payer: Aetna Commercial |
$7,848.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,001.48
|
| Rate for Payer: Cash Price |
$7,386.43
|
| Rate for Payer: Cofinity Advantage |
$6,463.13
|
| Rate for Payer: Cofinity Commercial |
$7,940.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,386.43
|
| Rate for Payer: Healthscope Commercial |
$8,309.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,848.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,924.78
|
| Rate for Payer: PHP Commercial |
$7,848.08
|
| Rate for Payer: Priority Health SBD |
$5,816.82
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
IP
|
$20,314.40
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,798.07 |
| Max. Negotiated Rate |
$18,282.96 |
| Rate for Payer: Aetna Commercial |
$17,267.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,204.36
|
| Rate for Payer: Cash Price |
$16,251.52
|
| Rate for Payer: Cofinity Advantage |
$14,220.08
|
| Rate for Payer: Cofinity Commercial |
$17,470.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,251.52
|
| Rate for Payer: Healthscope Commercial |
$18,282.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,267.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,235.80
|
| Rate for Payer: PHP Commercial |
$17,267.24
|
| Rate for Payer: Priority Health SBD |
$12,798.07
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
OP
|
$20,314.40
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,446.74 |
| Max. Negotiated Rate |
$33,679.26 |
| Rate for Payer: Aetna Commercial |
$17,267.24
|
| Rate for Payer: Aetna Medicare |
$10,830.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,204.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,018.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,018.01
|
| Rate for Payer: BCBS Complete |
$5,719.59
|
| Rate for Payer: BCBS MAPPO |
$10,414.41
|
| Rate for Payer: BCBS Trust/PPO |
$10,087.49
|
| Rate for Payer: BCN Commercial |
$10,087.49
|
| Rate for Payer: BCN Medicare Advantage |
$10,414.41
|
| Rate for Payer: Cash Price |
$16,251.52
|
| Rate for Payer: Cash Price |
$16,251.52
|
| Rate for Payer: Cash Price |
$16,251.52
|
| Rate for Payer: Cofinity Advantage |
$14,220.08
|
| Rate for Payer: Cofinity Commercial |
$17,470.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,251.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,414.41
|
| Rate for Payer: Healthscope Commercial |
$18,282.96
|
| Rate for Payer: Mclaren Medicaid |
$5,446.74
|
| Rate for Payer: Mclaren Medicare |
$10,414.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,935.13
|
| Rate for Payer: Meridian Medicaid |
$10,935.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,976.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,455.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,267.24
|
| Rate for Payer: Nomi Health Commercial |
$31,243.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,235.80
|
| Rate for Payer: PACE Medicare |
$9,893.69
|
| Rate for Payer: PACE SWMI |
$10,414.41
|
| Rate for Payer: PHP Commercial |
$17,267.24
|
| Rate for Payer: PHP Medicare Advantage |
$10,414.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,446.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,679.26
|
| Rate for Payer: Priority Health Medicare |
$10,414.41
|
| Rate for Payer: Priority Health SBD |
$12,798.07
|
| Rate for Payer: Priority Health Tiered Network |
$26,943.41
|
| Rate for Payer: Railroad Medicare Medicare |
$10,414.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,414.41
|
| Rate for Payer: UHC Medicaid |
$5,446.74
|
| Rate for Payer: UHCCP Medicaid |
$5,446.74
|
| Rate for Payer: VA VA |
$10,414.41
|
|
|
HC PACEMAKER LEAD
|
Facility
|
OP
|
$1,988.20
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$781.36 |
| Max. Negotiated Rate |
$1,789.38 |
| Rate for Payer: Aetna Commercial |
$1,689.97
|
| Rate for Payer: Aetna Medicare |
$994.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.33
|
| Rate for Payer: BCBS Complete |
$795.28
|
| Rate for Payer: Cash Price |
$1,590.56
|
| Rate for Payer: Cofinity Advantage |
$1,391.74
|
| Rate for Payer: Cofinity Commercial |
$1,709.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.56
|
| Rate for Payer: Healthscope Commercial |
$1,789.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,590.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.15
|
| Rate for Payer: PHP Commercial |
$1,689.97
|
| Rate for Payer: Priority Health SBD |
$1,252.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,292.33
|
| Rate for Payer: UHC Core |
$1,035.85
|
| Rate for Payer: UHC Exchange |
$781.36
|
|
|
HC PACEMAKER LEAD
|
Facility
|
IP
|
$1,988.20
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.57 |
| Max. Negotiated Rate |
$1,789.38 |
| Rate for Payer: Aetna Commercial |
$1,689.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.33
|
| Rate for Payer: Cash Price |
$1,590.56
|
| Rate for Payer: Cofinity Advantage |
$1,391.74
|
| Rate for Payer: Cofinity Commercial |
$1,709.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.56
|
| Rate for Payer: Healthscope Commercial |
$1,789.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.15
|
| Rate for Payer: PHP Commercial |
$1,689.97
|
| Rate for Payer: Priority Health SBD |
$1,252.57
|
|
|
HC PACEMAKER OTHER SINGLE OR DUAL LVL 11
|
Facility
|
OP
|
$11,889.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,672.38 |
| Max. Negotiated Rate |
$10,700.10 |
| Rate for Payer: Aetna Commercial |
$10,105.65
|
| Rate for Payer: Aetna Medicare |
$5,944.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,727.85
|
| Rate for Payer: BCBS Complete |
$4,755.60
|
| Rate for Payer: Cash Price |
$9,511.20
|
| Rate for Payer: Cofinity Advantage |
$8,322.30
|
| Rate for Payer: Cofinity Commercial |
$10,224.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,511.20
|
| Rate for Payer: Healthscope Commercial |
$10,700.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,511.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,105.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,916.75
|
| Rate for Payer: PHP Commercial |
$10,105.65
|
| Rate for Payer: Priority Health SBD |
$7,490.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,727.85
|
| Rate for Payer: UHC Core |
$6,194.17
|
| Rate for Payer: UHC Exchange |
$4,672.38
|
|
|
HC PACEMAKER OTHER SINGLE OR DUAL LVL 11
|
Facility
|
IP
|
$11,889.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,490.07 |
| Max. Negotiated Rate |
$10,700.10 |
| Rate for Payer: Aetna Commercial |
$10,105.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,727.85
|
| Rate for Payer: Cash Price |
$9,511.20
|
| Rate for Payer: Cofinity Advantage |
$8,322.30
|
| Rate for Payer: Cofinity Commercial |
$10,224.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,511.20
|
| Rate for Payer: Healthscope Commercial |
$10,700.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,105.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,916.75
|
| Rate for Payer: PHP Commercial |
$10,105.65
|
| Rate for Payer: Priority Health SBD |
$7,490.07
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 13
|
Facility
|
OP
|
$13,770.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500351
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,411.61 |
| Max. Negotiated Rate |
$12,393.00 |
| Rate for Payer: Aetna Commercial |
$11,704.50
|
| Rate for Payer: Aetna Medicare |
$6,885.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,950.50
|
| Rate for Payer: BCBS Complete |
$5,508.00
|
| Rate for Payer: Cash Price |
$11,016.00
|
| Rate for Payer: Cofinity Advantage |
$9,639.00
|
| Rate for Payer: Cofinity Commercial |
$11,842.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,016.00
|
| Rate for Payer: Healthscope Commercial |
$12,393.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,016.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,704.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,327.50
|
| Rate for Payer: PHP Commercial |
$11,704.50
|
| Rate for Payer: Priority Health SBD |
$8,675.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,950.50
|
| Rate for Payer: UHC Core |
$7,174.17
|
| Rate for Payer: UHC Exchange |
$5,411.61
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 13
|
Facility
|
IP
|
$13,770.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500351
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,675.10 |
| Max. Negotiated Rate |
$12,393.00 |
| Rate for Payer: Aetna Commercial |
$11,704.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,950.50
|
| Rate for Payer: Cash Price |
$11,016.00
|
| Rate for Payer: Cofinity Advantage |
$9,639.00
|
| Rate for Payer: Cofinity Commercial |
$11,842.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,016.00
|
| Rate for Payer: Healthscope Commercial |
$12,393.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,704.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,327.50
|
| Rate for Payer: PHP Commercial |
$11,704.50
|
| Rate for Payer: Priority Health SBD |
$8,675.10
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 15
|
Facility
|
OP
|
$15,812.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500015
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,214.31 |
| Max. Negotiated Rate |
$14,231.25 |
| Rate for Payer: Aetna Commercial |
$13,440.62
|
| Rate for Payer: Aetna Medicare |
$7,906.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,278.12
|
| Rate for Payer: BCBS Complete |
$6,325.00
|
| Rate for Payer: Cash Price |
$12,650.00
|
| Rate for Payer: Cofinity Advantage |
$11,068.75
|
| Rate for Payer: Cofinity Commercial |
$13,598.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,650.00
|
| Rate for Payer: Healthscope Commercial |
$14,231.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,650.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,440.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,859.38
|
| Rate for Payer: PHP Commercial |
$13,440.62
|
| Rate for Payer: Priority Health SBD |
$9,961.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,278.12
|
| Rate for Payer: UHC Core |
$8,238.31
|
| Rate for Payer: UHC Exchange |
$6,214.31
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 15
|
Facility
|
IP
|
$15,812.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500015
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,961.88 |
| Max. Negotiated Rate |
$14,231.25 |
| Rate for Payer: Aetna Commercial |
$13,440.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,278.12
|
| Rate for Payer: Cash Price |
$12,650.00
|
| Rate for Payer: Cofinity Advantage |
$11,068.75
|
| Rate for Payer: Cofinity Commercial |
$13,598.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,650.00
|
| Rate for Payer: Healthscope Commercial |
$14,231.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,440.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,859.38
|
| Rate for Payer: PHP Commercial |
$13,440.62
|
| Rate for Payer: Priority Health SBD |
$9,961.88
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 16
|
Facility
|
OP
|
$16,863.15
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,627.22 |
| Max. Negotiated Rate |
$15,176.83 |
| Rate for Payer: Aetna Commercial |
$14,333.68
|
| Rate for Payer: Aetna Medicare |
$8,431.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,961.05
|
| Rate for Payer: BCBS Complete |
$6,745.26
|
| Rate for Payer: Cash Price |
$13,490.52
|
| Rate for Payer: Cofinity Advantage |
$11,804.20
|
| Rate for Payer: Cofinity Commercial |
$14,502.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,490.52
|
| Rate for Payer: Healthscope Commercial |
$15,176.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,490.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,333.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,647.36
|
| Rate for Payer: PHP Commercial |
$14,333.68
|
| Rate for Payer: Priority Health SBD |
$10,623.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,961.05
|
| Rate for Payer: UHC Core |
$8,785.70
|
| Rate for Payer: UHC Exchange |
$6,627.22
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 16
|
Facility
|
IP
|
$16,863.15
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,623.78 |
| Max. Negotiated Rate |
$15,176.83 |
| Rate for Payer: Aetna Commercial |
$14,333.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,961.05
|
| Rate for Payer: Cash Price |
$13,490.52
|
| Rate for Payer: Cofinity Advantage |
$11,804.20
|
| Rate for Payer: Cofinity Commercial |
$14,502.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,490.52
|
| Rate for Payer: Healthscope Commercial |
$15,176.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,333.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,647.36
|
| Rate for Payer: PHP Commercial |
$14,333.68
|
| Rate for Payer: Priority Health SBD |
$10,623.78
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
OP
|
$6,319.92
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,483.73 |
| Max. Negotiated Rate |
$5,687.93 |
| Rate for Payer: Aetna Commercial |
$5,371.93
|
| Rate for Payer: Aetna Medicare |
$3,159.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,107.95
|
| Rate for Payer: BCBS Complete |
$2,527.97
|
| Rate for Payer: Cash Price |
$5,055.94
|
| Rate for Payer: Cofinity Advantage |
$4,423.94
|
| Rate for Payer: Cofinity Commercial |
$5,435.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,055.94
|
| Rate for Payer: Healthscope Commercial |
$5,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,055.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,371.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,739.94
|
| Rate for Payer: PHP Commercial |
$5,371.93
|
| Rate for Payer: Priority Health SBD |
$3,981.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,107.95
|
| Rate for Payer: UHC Core |
$3,292.68
|
| Rate for Payer: UHC Exchange |
$2,483.73
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
IP
|
$6,319.92
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,981.55 |
| Max. Negotiated Rate |
$5,687.93 |
| Rate for Payer: Aetna Commercial |
$5,371.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,107.95
|
| Rate for Payer: Cash Price |
$5,055.94
|
| Rate for Payer: Cofinity Advantage |
$4,423.94
|
| Rate for Payer: Cofinity Commercial |
$5,435.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,055.94
|
| Rate for Payer: Healthscope Commercial |
$5,687.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,371.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,739.94
|
| Rate for Payer: PHP Commercial |
$5,371.93
|
| Rate for Payer: Priority Health SBD |
$3,981.55
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
OP
|
$8,315.04
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,267.81 |
| Max. Negotiated Rate |
$7,483.54 |
| Rate for Payer: Aetna Commercial |
$7,067.78
|
| Rate for Payer: Aetna Medicare |
$4,157.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,404.78
|
| Rate for Payer: BCBS Complete |
$3,326.02
|
| Rate for Payer: Cash Price |
$6,652.03
|
| Rate for Payer: Cofinity Advantage |
$5,820.53
|
| Rate for Payer: Cofinity Commercial |
$7,150.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,652.03
|
| Rate for Payer: Healthscope Commercial |
$7,483.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,652.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,067.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,236.28
|
| Rate for Payer: PHP Commercial |
$7,067.78
|
| Rate for Payer: Priority Health SBD |
$5,238.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,404.78
|
| Rate for Payer: UHC Core |
$4,332.14
|
| Rate for Payer: UHC Exchange |
$3,267.81
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
IP
|
$8,315.04
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,238.48 |
| Max. Negotiated Rate |
$7,483.54 |
| Rate for Payer: Aetna Commercial |
$7,067.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,404.78
|
| Rate for Payer: Cash Price |
$6,652.03
|
| Rate for Payer: Cofinity Advantage |
$5,820.53
|
| Rate for Payer: Cofinity Commercial |
$7,150.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,652.03
|
| Rate for Payer: Healthscope Commercial |
$7,483.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,067.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,236.28
|
| Rate for Payer: PHP Commercial |
$7,067.78
|
| Rate for Payer: Priority Health SBD |
$5,238.48
|
|
|
HC PACEMAKER TESTING CABLE
|
Facility
|
OP
|
$116.98
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.97 |
| Max. Negotiated Rate |
$105.28 |
| Rate for Payer: Aetna Commercial |
$99.43
|
| Rate for Payer: Aetna Medicare |
$58.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.04
|
| Rate for Payer: BCBS Complete |
$46.79
|
| Rate for Payer: Cash Price |
$93.58
|
| Rate for Payer: Cofinity Advantage |
$81.89
|
| Rate for Payer: Cofinity Commercial |
$100.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.58
|
| Rate for Payer: Healthscope Commercial |
$105.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.73
|
| Rate for Payer: PHP Commercial |
$99.43
|
| Rate for Payer: Priority Health SBD |
$73.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.04
|
| Rate for Payer: UHC Core |
$60.95
|
| Rate for Payer: UHC Exchange |
$45.97
|
|
|
HC PACEMAKER TESTING CABLE
|
Facility
|
IP
|
$116.98
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.70 |
| Max. Negotiated Rate |
$105.28 |
| Rate for Payer: Aetna Commercial |
$99.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.04
|
| Rate for Payer: Cash Price |
$93.58
|
| Rate for Payer: Cofinity Advantage |
$81.89
|
| Rate for Payer: Cofinity Commercial |
$100.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.58
|
| Rate for Payer: Healthscope Commercial |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.73
|
| Rate for Payer: PHP Commercial |
$99.43
|
| Rate for Payer: Priority Health SBD |
$73.70
|
|
|
HC PACER POCKET REVISION
|
Facility
|
IP
|
$2,893.52
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,822.92 |
| Max. Negotiated Rate |
$2,604.17 |
| Rate for Payer: Aetna Commercial |
$2,459.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,880.79
|
| Rate for Payer: Cash Price |
$2,314.82
|
| Rate for Payer: Cofinity Advantage |
$2,025.46
|
| Rate for Payer: Cofinity Commercial |
$2,488.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,314.82
|
| Rate for Payer: Healthscope Commercial |
$2,604.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,459.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,170.14
|
| Rate for Payer: PHP Commercial |
$2,459.49
|
| Rate for Payer: Priority Health SBD |
$1,822.92
|
|
|
HC PACER POCKET REVISION
|
Facility
|
OP
|
$2,893.52
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,030.62 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Commercial |
$2,459.49
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,880.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.62
|
| Rate for Payer: BCN Commercial |
$1,030.62
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,314.82
|
| Rate for Payer: Cash Price |
$2,314.82
|
| Rate for Payer: Cash Price |
$2,314.82
|
| Rate for Payer: Cofinity Advantage |
$2,025.46
|
| Rate for Payer: Cofinity Commercial |
$2,488.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,314.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$2,604.17
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,459.49
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,170.14
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,459.49
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$1,822.92
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
IP
|
$780.30
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$491.59 |
| Max. Negotiated Rate |
$702.27 |
| Rate for Payer: Aetna Commercial |
$663.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.19
|
| Rate for Payer: Cash Price |
$624.24
|
| Rate for Payer: Cofinity Advantage |
$546.21
|
| Rate for Payer: Cofinity Commercial |
$671.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.24
|
| Rate for Payer: Healthscope Commercial |
$702.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.23
|
| Rate for Payer: PHP Commercial |
$663.25
|
| Rate for Payer: Priority Health SBD |
$491.59
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
OP
|
$780.30
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$306.66 |
| Max. Negotiated Rate |
$702.27 |
| Rate for Payer: Aetna Commercial |
$663.25
|
| Rate for Payer: Aetna Medicare |
$390.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.19
|
| Rate for Payer: BCBS Complete |
$312.12
|
| Rate for Payer: Cash Price |
$624.24
|
| Rate for Payer: Cofinity Advantage |
$546.21
|
| Rate for Payer: Cofinity Commercial |
$671.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.24
|
| Rate for Payer: Healthscope Commercial |
$702.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$624.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.23
|
| Rate for Payer: PHP Commercial |
$663.25
|
| Rate for Payer: Priority Health SBD |
$491.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.19
|
| Rate for Payer: UHC Core |
$406.54
|
| Rate for Payer: UHC Exchange |
$306.66
|
|
|
HC PACKED CELLS DIRECT
|
Facility
|
OP
|
$841.79
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$757.61 |
| Rate for Payer: Aetna Commercial |
$715.52
|
| Rate for Payer: Aetna Medicare |
$187.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.43
|
| Rate for Payer: BCBS Complete |
$99.04
|
| Rate for Payer: BCBS MAPPO |
$180.34
|
| Rate for Payer: BCBS Trust/PPO |
$505.91
|
| Rate for Payer: BCN Commercial |
$505.91
|
| Rate for Payer: BCN Medicare Advantage |
$180.34
|
| Rate for Payer: Cash Price |
$673.43
|
| Rate for Payer: Cash Price |
$673.43
|
| Rate for Payer: Cofinity Advantage |
$589.25
|
| Rate for Payer: Cofinity Commercial |
$723.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.34
|
| Rate for Payer: Healthscope Commercial |
$757.61
|
| Rate for Payer: Mclaren Medicaid |
$94.32
|
| Rate for Payer: Mclaren Medicare |
$180.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.36
|
| Rate for Payer: Meridian Medicaid |
$189.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$198.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.52
|
| Rate for Payer: Nomi Health Commercial |
$541.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.34
|
| Rate for Payer: PACE Medicare |
$171.32
|
| Rate for Payer: PACE SWMI |
$180.34
|
| Rate for Payer: PHP Commercial |
$715.52
|
| Rate for Payer: PHP Medicare Advantage |
$180.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$583.21
|
| Rate for Payer: Priority Health Medicare |
$180.34
|
| Rate for Payer: Priority Health SBD |
$530.33
|
| Rate for Payer: Priority Health Tiered Network |
$466.57
|
| Rate for Payer: Railroad Medicare Medicare |
$180.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.16
|
| Rate for Payer: UHC Core |
$438.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$180.34
|
| Rate for Payer: UHC Exchange |
$330.82
|
| Rate for Payer: UHC Medicaid |
$94.32
|
| Rate for Payer: UHCCP Medicaid |
$94.32
|
| Rate for Payer: VA VA |
$180.34
|
|
