|
HC PACEMAKER TESTING CABLE
|
Facility
|
OP
|
$114.69
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$103.22 |
| Rate for Payer: Aetna Commercial |
$97.49
|
| Rate for Payer: Aetna Medicare |
$57.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.55
|
| Rate for Payer: BCBS Complete |
$45.88
|
| Rate for Payer: Cash Price |
$91.75
|
| Rate for Payer: Cofinity Commercial |
$80.28
|
| Rate for Payer: Cofinity Commercial |
$98.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.75
|
| Rate for Payer: Healthscope Commercial |
$103.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.49
|
| Rate for Payer: PHP Commercial |
$97.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.55
|
| Rate for Payer: Priority Health SBD |
$72.25
|
|
|
HC PACER POCKET REVISION
|
Facility
|
OP
|
$2,755.73
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Commercial |
$2,342.37
|
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,791.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$2,369.93
|
| Rate for Payer: Cofinity Commercial |
$1,929.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,929.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$2,480.16
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.37
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$2,342.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.22
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health SBD |
$1,736.11
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$1,004.40
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
HC PACER POCKET REVISION
|
Facility
|
IP
|
$2,755.73
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,736.11 |
| Max. Negotiated Rate |
$2,480.16 |
| Rate for Payer: Aetna Commercial |
$2,342.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,791.22
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$1,929.01
|
| Rate for Payer: Cofinity Commercial |
$2,369.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,929.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.58
|
| Rate for Payer: Healthscope Commercial |
$2,480.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.37
|
| Rate for Payer: PHP Commercial |
$2,342.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.22
|
| Rate for Payer: Priority Health SBD |
$1,736.11
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
OP
|
$765.00
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: Aetna Commercial |
$650.25
|
| Rate for Payer: Aetna Medicare |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.25
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$535.50
|
| Rate for Payer: Cofinity Commercial |
$657.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$535.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.00
|
| Rate for Payer: Healthscope Commercial |
$688.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.25
|
| Rate for Payer: PHP Commercial |
$650.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health SBD |
$481.95
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
IP
|
$765.00
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$481.95 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: Aetna Commercial |
$650.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.25
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$535.50
|
| Rate for Payer: Cofinity Commercial |
$657.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$535.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.00
|
| Rate for Payer: Healthscope Commercial |
$688.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.25
|
| Rate for Payer: PHP Commercial |
$650.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health SBD |
$481.95
|
|
|
HC PACKED CELLS DIRECT
|
Facility
|
IP
|
$825.28
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$519.93 |
| Max. Negotiated Rate |
$742.75 |
| Rate for Payer: Aetna Commercial |
$701.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.43
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cofinity Commercial |
$577.70
|
| Rate for Payer: Cofinity Commercial |
$709.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.22
|
| Rate for Payer: Healthscope Commercial |
$742.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.49
|
| Rate for Payer: PHP Commercial |
$701.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.43
|
| Rate for Payer: Priority Health SBD |
$519.93
|
|
|
HC PACKED CELLS DIRECT
|
Facility
|
OP
|
$825.28
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$95.14 |
| Max. Negotiated Rate |
$742.75 |
| Rate for Payer: Aetna Commercial |
$701.49
|
| Rate for Payer: Aetna Medicare |
$184.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.88
|
| Rate for Payer: BCBS Complete |
$99.90
|
| Rate for Payer: BCBS MAPPO |
$177.50
|
| Rate for Payer: BCN Medicare Advantage |
$177.50
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cofinity Commercial |
$577.70
|
| Rate for Payer: Cofinity Commercial |
$709.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.50
|
| Rate for Payer: Healthscope Commercial |
$742.75
|
| Rate for Payer: Mclaren Medicaid |
$95.14
|
| Rate for Payer: Mclaren Medicare |
$177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.38
|
| Rate for Payer: Meridian Medicaid |
$99.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.49
|
| Rate for Payer: PACE Medicare |
$168.62
|
| Rate for Payer: PACE SWMI |
$177.50
|
| Rate for Payer: PHP Commercial |
$701.49
|
| Rate for Payer: PHP Medicare Advantage |
$177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.43
|
| Rate for Payer: Priority Health Medicare |
$177.50
|
| Rate for Payer: Priority Health SBD |
$519.93
|
| Rate for Payer: Railroad Medicare Medicare |
$177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$499.64
|
| Rate for Payer: UHC Core |
$610.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.50
|
| Rate for Payer: UHC Exchange |
$610.71
|
| Rate for Payer: UHC Medicare Advantage |
$177.50
|
| Rate for Payer: UHCCP Medicaid |
$99.93
|
| Rate for Payer: VA VA |
$177.50
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
OP
|
$1,257.09
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$133.72 |
| Max. Negotiated Rate |
$1,131.38 |
| Rate for Payer: Aetna Commercial |
$1,068.53
|
| Rate for Payer: Aetna Medicare |
$259.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$817.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.85
|
| Rate for Payer: BCBS Complete |
$140.41
|
| Rate for Payer: BCBS MAPPO |
$249.48
|
| Rate for Payer: BCN Medicare Advantage |
$249.48
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cofinity Commercial |
$879.96
|
| Rate for Payer: Cofinity Commercial |
$1,081.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$879.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,005.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.48
|
| Rate for Payer: Healthscope Commercial |
$1,131.38
|
| Rate for Payer: Mclaren Medicaid |
$133.72
|
| Rate for Payer: Mclaren Medicare |
$249.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.95
|
| Rate for Payer: Meridian Medicaid |
$140.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.53
|
| Rate for Payer: PACE Medicare |
$237.01
|
| Rate for Payer: PACE SWMI |
$249.48
|
| Rate for Payer: PHP Commercial |
$1,068.53
|
| Rate for Payer: PHP Medicare Advantage |
$249.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.11
|
| Rate for Payer: Priority Health Medicare |
$249.48
|
| Rate for Payer: Priority Health SBD |
$791.97
|
| Rate for Payer: Railroad Medicare Medicare |
$249.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$702.26
|
| Rate for Payer: UHC Core |
$930.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.48
|
| Rate for Payer: UHC Exchange |
$930.25
|
| Rate for Payer: UHC Medicare Advantage |
$249.48
|
| Rate for Payer: UHCCP Medicaid |
$140.46
|
| Rate for Payer: VA VA |
$249.48
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
IP
|
$1,257.09
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$791.97 |
| Max. Negotiated Rate |
$1,131.38 |
| Rate for Payer: Aetna Commercial |
$1,068.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$817.11
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cofinity Commercial |
$1,081.10
|
| Rate for Payer: Cofinity Commercial |
$879.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$879.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,005.67
|
| Rate for Payer: Healthscope Commercial |
$1,131.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.53
|
| Rate for Payer: PHP Commercial |
$1,068.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.11
|
| Rate for Payer: Priority Health SBD |
$791.97
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
OP
|
$97.92
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.17 |
| Max. Negotiated Rate |
$88.13 |
| Rate for Payer: Aetna Commercial |
$83.23
|
| Rate for Payer: Aetna Medicare |
$48.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.65
|
| Rate for Payer: BCBS Complete |
$39.17
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$84.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.34
|
| Rate for Payer: Healthscope Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.23
|
| Rate for Payer: PHP Commercial |
$83.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.65
|
| Rate for Payer: Priority Health SBD |
$61.69
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
IP
|
$97.92
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.69 |
| Max. Negotiated Rate |
$88.13 |
| Rate for Payer: Aetna Commercial |
$83.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.65
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$84.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.34
|
| Rate for Payer: Healthscope Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.23
|
| Rate for Payer: PHP Commercial |
$83.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.65
|
| Rate for Payer: Priority Health SBD |
$61.69
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
IP
|
$688.50
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$433.75 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Aetna Commercial |
$585.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.52
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Commercial |
$481.95
|
| Rate for Payer: Cofinity Commercial |
$592.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Healthscope Commercial |
$619.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.23
|
| Rate for Payer: PHP Commercial |
$585.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.52
|
| Rate for Payer: Priority Health SBD |
$433.75
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
OP
|
$688.50
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Aetna Commercial |
$585.23
|
| Rate for Payer: Aetna Medicare |
$344.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.52
|
| Rate for Payer: BCBS Complete |
$275.40
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Commercial |
$481.95
|
| Rate for Payer: Cofinity Commercial |
$592.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Healthscope Commercial |
$619.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.23
|
| Rate for Payer: PHP Commercial |
$585.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.52
|
| Rate for Payer: Priority Health SBD |
$433.75
|
|
|
HC PACK TABLE LINE
|
Facility
|
OP
|
$205.02
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$184.52 |
| Rate for Payer: Aetna Commercial |
$174.27
|
| Rate for Payer: Aetna Medicare |
$102.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.26
|
| Rate for Payer: BCBS Complete |
$82.01
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Cofinity Commercial |
$143.51
|
| Rate for Payer: Cofinity Commercial |
$176.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.02
|
| Rate for Payer: Healthscope Commercial |
$184.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.27
|
| Rate for Payer: PHP Commercial |
$174.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.26
|
| Rate for Payer: Priority Health SBD |
$129.16
|
|
|
HC PACK TABLE LINE
|
Facility
|
IP
|
$205.02
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$129.16 |
| Max. Negotiated Rate |
$184.52 |
| Rate for Payer: Aetna Commercial |
$174.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.26
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Cofinity Commercial |
$143.51
|
| Rate for Payer: Cofinity Commercial |
$176.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.02
|
| Rate for Payer: Healthscope Commercial |
$184.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.27
|
| Rate for Payer: PHP Commercial |
$174.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.26
|
| Rate for Payer: Priority Health SBD |
$129.16
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
OP
|
$841.50
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$757.35 |
| Rate for Payer: Aetna Commercial |
$715.27
|
| Rate for Payer: Aetna Medicare |
$420.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.98
|
| Rate for Payer: BCBS Complete |
$336.60
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cofinity Commercial |
$589.05
|
| Rate for Payer: Cofinity Commercial |
$723.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$589.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.20
|
| Rate for Payer: Healthscope Commercial |
$757.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.27
|
| Rate for Payer: PHP Commercial |
$715.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.98
|
| Rate for Payer: Priority Health SBD |
$530.14
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
IP
|
$841.50
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$530.14 |
| Max. Negotiated Rate |
$757.35 |
| Rate for Payer: Aetna Commercial |
$715.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.98
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cofinity Commercial |
$589.05
|
| Rate for Payer: Cofinity Commercial |
$723.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$589.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.20
|
| Rate for Payer: Healthscope Commercial |
$757.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.27
|
| Rate for Payer: PHP Commercial |
$715.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.98
|
| Rate for Payer: Priority Health SBD |
$530.14
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
OP
|
$164.38
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Cofinity Commercial |
$115.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$147.94
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.85
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$103.56
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
IP
|
$164.38
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.56 |
| Max. Negotiated Rate |
$147.94 |
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Commercial |
$115.07
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Healthscope Commercial |
$147.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.85
|
| Rate for Payer: Priority Health SBD |
$103.56
|
|
|
HC PAIN PUMP ADJUSTMENT
|
Facility
|
IP
|
$151.79
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.63 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.66
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.02
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.66
|
| Rate for Payer: Priority Health SBD |
$95.63
|
|
|
HC PAIN PUMP ADJUSTMENT
|
Facility
|
OP
|
$151.79
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.72 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna Medicare |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.66
|
| Rate for Payer: BCBS Complete |
$60.72
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.02
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.66
|
| Rate for Payer: Priority Health SBD |
$95.63
|
|
|
HC PAIN PUMP SUPPLY
|
Facility
|
OP
|
$923.62
|
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$369.45 |
| Max. Negotiated Rate |
$831.26 |
| Rate for Payer: Aetna Commercial |
$785.08
|
| Rate for Payer: Aetna Medicare |
$461.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.35
|
| Rate for Payer: BCBS Complete |
$369.45
|
| Rate for Payer: Cash Price |
$738.90
|
| Rate for Payer: Cofinity Commercial |
$646.53
|
| Rate for Payer: Cofinity Commercial |
$794.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$646.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.90
|
| Rate for Payer: Healthscope Commercial |
$831.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.08
|
| Rate for Payer: PHP Commercial |
$785.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.35
|
| Rate for Payer: Priority Health SBD |
$581.88
|
|
|
HC PAIN PUMP SUPPLY
|
Facility
|
IP
|
$923.62
|
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$581.88 |
| Max. Negotiated Rate |
$831.26 |
| Rate for Payer: Aetna Commercial |
$785.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.35
|
| Rate for Payer: Cash Price |
$738.90
|
| Rate for Payer: Cofinity Commercial |
$646.53
|
| Rate for Payer: Cofinity Commercial |
$794.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$646.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.90
|
| Rate for Payer: Healthscope Commercial |
$831.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.08
|
| Rate for Payer: PHP Commercial |
$785.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.35
|
| Rate for Payer: Priority Health SBD |
$581.88
|
|
|
HC PANCREATIC AMYLASE
|
Facility
|
OP
|
$67.32
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$57.22
|
| Rate for Payer: Aetna Medicare |
$6.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.10
|
| Rate for Payer: BCBS Complete |
$3.65
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Cofinity Commercial |
$47.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$60.59
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.22
|
| Rate for Payer: PACE Medicare |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$57.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health SBD |
$42.41
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.48
|
| Rate for Payer: UHC Medicare Advantage |
$6.48
|
| Rate for Payer: UHCCP Medicaid |
$3.65
|
| Rate for Payer: VA VA |
$6.48
|
|
|
HC PANCREATIC AMYLASE
|
Facility
|
IP
|
$67.32
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$57.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.76
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$47.12
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Healthscope Commercial |
$60.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.22
|
| Rate for Payer: PHP Commercial |
$57.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: Priority Health SBD |
$42.41
|
|
