|
HC TRANS CARE MGMT 7 DAYS
|
Facility
|
IP
|
$122.04
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$109.84 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.33
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cofinity Advantage |
$85.43
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.63
|
| Rate for Payer: Healthscope Commercial |
$109.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.53
|
| Rate for Payer: PHP Commercial |
$103.73
|
| Rate for Payer: Priority Health SBD |
$76.89
|
|
|
HC TRANS CARE MGMT 7 DAYS
|
Facility
|
OP
|
$122.04
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$428.99 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cofinity Advantage |
$85.43
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$109.84
|
| Rate for Payer: Mclaren Medicaid |
$69.38
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.73
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.53
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$103.73
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$76.89
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.33
|
| Rate for Payer: UHC Core |
$63.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$47.96
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
HC TRANSCATH INSERT/REPLACE LDLS PACEMAKER DUAL CHAMBER
|
Facility
|
IP
|
$47,677.90
|
|
|
Service Code
|
CPT 0795T
|
| Hospital Charge Code |
48100139
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$30,037.08 |
| Max. Negotiated Rate |
$42,910.11 |
| Rate for Payer: Aetna Commercial |
$40,526.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,990.63
|
| Rate for Payer: Cash Price |
$38,142.32
|
| Rate for Payer: Cofinity Advantage |
$33,374.53
|
| Rate for Payer: Cofinity Commercial |
$41,002.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,142.32
|
| Rate for Payer: Healthscope Commercial |
$42,910.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,526.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,758.43
|
| Rate for Payer: PHP Commercial |
$40,526.21
|
| Rate for Payer: Priority Health SBD |
$30,037.08
|
|
|
HC TRANSCATH INSERT/REPLACE LDLS PACEMAKER DUAL CHAMBER
|
Facility
|
OP
|
$47,677.90
|
|
|
Service Code
|
CPT 0795T
|
| Hospital Charge Code |
48100139
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,037.64 |
| Max. Negotiated Rate |
$62,066.59 |
| Rate for Payer: Aetna Commercial |
$40,526.21
|
| Rate for Payer: Aetna Medicare |
$19,960.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,990.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,990.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,990.54
|
| Rate for Payer: BCBS Complete |
$10,540.48
|
| Rate for Payer: BCBS MAPPO |
$19,192.43
|
| Rate for Payer: BCN Medicare Advantage |
$19,192.43
|
| Rate for Payer: Cash Price |
$38,142.32
|
| Rate for Payer: Cash Price |
$38,142.32
|
| Rate for Payer: Cofinity Advantage |
$33,374.53
|
| Rate for Payer: Cofinity Commercial |
$41,002.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,142.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,192.43
|
| Rate for Payer: Healthscope Commercial |
$42,910.11
|
| Rate for Payer: Mclaren Medicaid |
$10,037.64
|
| Rate for Payer: Mclaren Medicare |
$19,192.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,152.05
|
| Rate for Payer: Meridian Medicaid |
$20,152.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,071.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,111.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,526.21
|
| Rate for Payer: Nomi Health Commercial |
$57,577.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,758.43
|
| Rate for Payer: PACE Medicare |
$18,232.81
|
| Rate for Payer: PACE SWMI |
$19,192.43
|
| Rate for Payer: PHP Commercial |
$40,526.21
|
| Rate for Payer: PHP Medicare Advantage |
$19,192.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,037.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62,066.59
|
| Rate for Payer: Priority Health Medicare |
$19,192.43
|
| Rate for Payer: Priority Health SBD |
$30,037.08
|
| Rate for Payer: Priority Health Tiered Network |
$49,653.27
|
| Rate for Payer: Railroad Medicare Medicare |
$19,192.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,192.43
|
| Rate for Payer: UHC Medicaid |
$10,037.64
|
| Rate for Payer: UHCCP Medicaid |
$10,037.64
|
| Rate for Payer: VA VA |
$19,192.43
|
|
|
HC TRANSCATH INSERT/REPLACE LDLS PACEMAKER VENTRICULAR
|
Facility
|
OP
|
$25,468.99
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
48100115
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,037.64 |
| Max. Negotiated Rate |
$62,066.59 |
| Rate for Payer: Aetna Commercial |
$21,648.64
|
| Rate for Payer: Aetna Medicare |
$19,960.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,554.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,990.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,990.54
|
| Rate for Payer: BCBS Complete |
$10,540.48
|
| Rate for Payer: BCBS MAPPO |
$19,192.43
|
| Rate for Payer: BCBS Trust/PPO |
$13,505.92
|
| Rate for Payer: BCN Commercial |
$13,505.92
|
| Rate for Payer: BCN Medicare Advantage |
$19,192.43
|
| Rate for Payer: Cash Price |
$20,375.19
|
| Rate for Payer: Cash Price |
$20,375.19
|
| Rate for Payer: Cash Price |
$20,375.19
|
| Rate for Payer: Cofinity Advantage |
$17,828.29
|
| Rate for Payer: Cofinity Commercial |
$21,903.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,375.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,192.43
|
| Rate for Payer: Healthscope Commercial |
$22,922.09
|
| Rate for Payer: Mclaren Medicaid |
$10,037.64
|
| Rate for Payer: Mclaren Medicare |
$19,192.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,152.05
|
| Rate for Payer: Meridian Medicaid |
$20,152.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,071.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,111.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,648.64
|
| Rate for Payer: Nomi Health Commercial |
$57,577.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19,101.74
|
| Rate for Payer: PACE Medicare |
$18,232.81
|
| Rate for Payer: PACE SWMI |
$19,192.43
|
| Rate for Payer: PHP Commercial |
$21,648.64
|
| Rate for Payer: PHP Medicare Advantage |
$19,192.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,037.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62,066.59
|
| Rate for Payer: Priority Health Medicare |
$19,192.43
|
| Rate for Payer: Priority Health SBD |
$16,045.46
|
| Rate for Payer: Priority Health Tiered Network |
$49,653.27
|
| Rate for Payer: Railroad Medicare Medicare |
$19,192.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,192.43
|
| Rate for Payer: UHC Medicaid |
$10,037.64
|
| Rate for Payer: UHCCP Medicaid |
$10,037.64
|
| Rate for Payer: VA VA |
$19,192.43
|
|
|
HC TRANSCATH INSERT/REPLACE LDLS PACEMAKER VENTRICULAR
|
Facility
|
IP
|
$25,468.99
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
48100115
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,045.46 |
| Max. Negotiated Rate |
$22,922.09 |
| Rate for Payer: Aetna Commercial |
$21,648.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,554.84
|
| Rate for Payer: Cash Price |
$20,375.19
|
| Rate for Payer: Cofinity Advantage |
$17,828.29
|
| Rate for Payer: Cofinity Commercial |
$21,903.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,375.19
|
| Rate for Payer: Healthscope Commercial |
$22,922.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,648.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19,101.74
|
| Rate for Payer: PHP Commercial |
$21,648.64
|
| Rate for Payer: Priority Health SBD |
$16,045.46
|
|
|
HC TRANSCATH INSERT SINGLE CHAMBER LDLS PACEMAKER ATRIAL
|
Facility
|
OP
|
$47,677.90
|
|
|
Service Code
|
CPT 0823T
|
| Hospital Charge Code |
48100140
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,591.56 |
| Max. Negotiated Rate |
$66,490.77 |
| Rate for Payer: Aetna Commercial |
$40,526.21
|
| Rate for Payer: Aetna Medicare |
$23,050.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,990.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,704.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,704.49
|
| Rate for Payer: BCBS Complete |
$12,172.24
|
| Rate for Payer: BCBS MAPPO |
$22,163.59
|
| Rate for Payer: BCN Medicare Advantage |
$22,163.59
|
| Rate for Payer: Cash Price |
$38,142.32
|
| Rate for Payer: Cash Price |
$38,142.32
|
| Rate for Payer: Cofinity Advantage |
$33,374.53
|
| Rate for Payer: Cofinity Commercial |
$41,002.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,142.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,163.59
|
| Rate for Payer: Healthscope Commercial |
$42,910.11
|
| Rate for Payer: Mclaren Medicaid |
$11,591.56
|
| Rate for Payer: Mclaren Medicare |
$22,163.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,271.77
|
| Rate for Payer: Meridian Medicaid |
$23,271.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,488.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,379.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,526.21
|
| Rate for Payer: Nomi Health Commercial |
$66,490.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,758.43
|
| Rate for Payer: PACE Medicare |
$21,055.41
|
| Rate for Payer: PACE SWMI |
$22,163.59
|
| Rate for Payer: PHP Commercial |
$40,526.21
|
| Rate for Payer: PHP Medicare Advantage |
$22,163.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,591.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62,066.59
|
| Rate for Payer: Priority Health Medicare |
$22,163.59
|
| Rate for Payer: Priority Health SBD |
$30,037.08
|
| Rate for Payer: Priority Health Tiered Network |
$49,653.27
|
| Rate for Payer: Railroad Medicare Medicare |
$22,163.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,163.59
|
| Rate for Payer: UHC Medicaid |
$11,591.56
|
| Rate for Payer: UHCCP Medicaid |
$11,591.56
|
| Rate for Payer: VA VA |
$22,163.59
|
|
|
HC TRANSCATH INSERT SINGLE CHAMBER LDLS PACEMAKER ATRIAL
|
Facility
|
IP
|
$47,677.90
|
|
|
Service Code
|
CPT 0823T
|
| Hospital Charge Code |
48100140
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$30,037.08 |
| Max. Negotiated Rate |
$42,910.11 |
| Rate for Payer: Aetna Commercial |
$40,526.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,990.63
|
| Rate for Payer: Cash Price |
$38,142.32
|
| Rate for Payer: Cofinity Advantage |
$33,374.53
|
| Rate for Payer: Cofinity Commercial |
$41,002.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,142.32
|
| Rate for Payer: Healthscope Commercial |
$42,910.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,526.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,758.43
|
| Rate for Payer: PHP Commercial |
$40,526.21
|
| Rate for Payer: Priority Health SBD |
$30,037.08
|
|
|
HC TRANS CATH MITRAL VALVE IMPLNT/REPLACE
|
Facility
|
IP
|
$44,085.77
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
48100121
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$27,774.04 |
| Max. Negotiated Rate |
$39,677.19 |
| Rate for Payer: Aetna Commercial |
$37,472.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,655.75
|
| Rate for Payer: Cash Price |
$35,268.62
|
| Rate for Payer: Cofinity Advantage |
$30,860.04
|
| Rate for Payer: Cofinity Commercial |
$37,913.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,268.62
|
| Rate for Payer: Healthscope Commercial |
$39,677.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,472.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33,064.33
|
| Rate for Payer: PHP Commercial |
$37,472.90
|
| Rate for Payer: Priority Health SBD |
$27,774.04
|
|
|
HC TRANS CATH MITRAL VALVE IMPLNT/REPLACE
|
Facility
|
OP
|
$44,085.77
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
48100121
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,634.31 |
| Max. Negotiated Rate |
$39,677.19 |
| Rate for Payer: Aetna Commercial |
$37,472.90
|
| Rate for Payer: Aetna Medicare |
$22,042.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,655.75
|
| Rate for Payer: BCBS Complete |
$17,634.31
|
| Rate for Payer: Cash Price |
$35,268.62
|
| Rate for Payer: Cofinity Advantage |
$30,860.04
|
| Rate for Payer: Cofinity Commercial |
$37,913.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,268.62
|
| Rate for Payer: Healthscope Commercial |
$39,677.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,268.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,472.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33,064.33
|
| Rate for Payer: PHP Commercial |
$37,472.90
|
| Rate for Payer: Priority Health SBD |
$27,774.04
|
|
|
HC TRANSCATH PERM OCCLS/EMBOL NON CNS HEAD/NECK
|
Facility
|
OP
|
$25,176.45
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
36100660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$21,399.98
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,364.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$6,695.86
|
| Rate for Payer: BCN Commercial |
$6,695.86
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$20,141.16
|
| Rate for Payer: Cash Price |
$20,141.16
|
| Rate for Payer: Cash Price |
$20,141.16
|
| Rate for Payer: Cofinity Advantage |
$17,623.51
|
| Rate for Payer: Cofinity Commercial |
$21,651.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,141.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$22,658.81
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,399.98
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,882.34
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$21,399.98
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$15,861.16
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC TRANSCATH PERM OCCLS/EMBOL NON CNS HEAD/NECK
|
Facility
|
IP
|
$25,176.45
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
36100660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,861.16 |
| Max. Negotiated Rate |
$22,658.81 |
| Rate for Payer: Aetna Commercial |
$21,399.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,364.69
|
| Rate for Payer: Cash Price |
$20,141.16
|
| Rate for Payer: Cofinity Advantage |
$17,623.51
|
| Rate for Payer: Cofinity Commercial |
$21,651.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,141.16
|
| Rate for Payer: Healthscope Commercial |
$22,658.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,399.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,882.34
|
| Rate for Payer: PHP Commercial |
$21,399.98
|
| Rate for Payer: Priority Health SBD |
$15,861.16
|
|
|
HC TRANSCATH PERM OCCLS/EMBOL PERQ CNS
|
Facility
|
OP
|
$11,674.67
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100659
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,104.96 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$9,923.47
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,588.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,104.96
|
| Rate for Payer: BCN Commercial |
$3,104.96
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$9,339.74
|
| Rate for Payer: Cash Price |
$9,339.74
|
| Rate for Payer: Cash Price |
$9,339.74
|
| Rate for Payer: Cofinity Advantage |
$8,172.27
|
| Rate for Payer: Cofinity Commercial |
$10,040.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,339.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$10,507.20
|
| Rate for Payer: Mclaren Medicaid |
$9,552.97
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$19,179.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,923.47
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,756.00
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$9,923.47
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,069.70
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health SBD |
$7,355.04
|
| Rate for Payer: Priority Health Tiered Network |
$47,255.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC TRANSCATH PERM OCCLS/EMBOL PERQ CNS
|
Facility
|
IP
|
$11,674.67
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100659
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,355.04 |
| Max. Negotiated Rate |
$10,507.20 |
| Rate for Payer: Aetna Commercial |
$9,923.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,588.54
|
| Rate for Payer: Cash Price |
$9,339.74
|
| Rate for Payer: Cofinity Advantage |
$8,172.27
|
| Rate for Payer: Cofinity Commercial |
$10,040.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,339.74
|
| Rate for Payer: Healthscope Commercial |
$10,507.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,923.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,756.00
|
| Rate for Payer: PHP Commercial |
$9,923.47
|
| Rate for Payer: Priority Health SBD |
$7,355.04
|
|
|
HC TRANSCATH REMOVAL PERM LEADLESS PACEMAKER
|
Facility
|
IP
|
$3,968.92
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
48100116
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,500.42 |
| Max. Negotiated Rate |
$3,572.03 |
| Rate for Payer: Aetna Commercial |
$3,373.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,579.80
|
| Rate for Payer: Cash Price |
$3,175.14
|
| Rate for Payer: Cofinity Advantage |
$2,778.24
|
| Rate for Payer: Cofinity Commercial |
$3,413.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,175.14
|
| Rate for Payer: Healthscope Commercial |
$3,572.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,373.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,976.69
|
| Rate for Payer: PHP Commercial |
$3,373.58
|
| Rate for Payer: Priority Health SBD |
$2,500.42
|
|
|
HC TRANSCATH REMOVAL PERM LEADLESS PACEMAKER
|
Facility
|
OP
|
$3,968.92
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
48100116
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,373.58
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,579.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.29
|
| Rate for Payer: BCN Commercial |
$1,661.29
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,175.14
|
| Rate for Payer: Cash Price |
$3,175.14
|
| Rate for Payer: Cash Price |
$3,175.14
|
| Rate for Payer: Cofinity Advantage |
$2,778.24
|
| Rate for Payer: Cofinity Commercial |
$3,413.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,175.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,572.03
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,373.58
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,976.69
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,373.58
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,500.42
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC TRANS CATH REPAIR MITRAL VALVE ADDL
|
Facility
|
IP
|
$4,326.94
|
|
|
Service Code
|
CPT 33419
|
| Hospital Charge Code |
48100155
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,725.97 |
| Max. Negotiated Rate |
$3,894.25 |
| Rate for Payer: Aetna Commercial |
$3,677.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,812.51
|
| Rate for Payer: Cash Price |
$3,461.55
|
| Rate for Payer: Cofinity Advantage |
$3,028.86
|
| Rate for Payer: Cofinity Commercial |
$3,721.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,461.55
|
| Rate for Payer: Healthscope Commercial |
$3,894.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,677.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,245.20
|
| Rate for Payer: PHP Commercial |
$3,677.90
|
| Rate for Payer: Priority Health SBD |
$2,725.97
|
|
|
HC TRANS CATH REPAIR MITRAL VALVE ADDL
|
Facility
|
OP
|
$4,326.94
|
|
|
Service Code
|
CPT 33419
|
| Hospital Charge Code |
48100155
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,150.78 |
| Max. Negotiated Rate |
$3,894.25 |
| Rate for Payer: Aetna Commercial |
$3,677.90
|
| Rate for Payer: Aetna Medicare |
$2,163.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,812.51
|
| Rate for Payer: BCBS Complete |
$1,730.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,150.78
|
| Rate for Payer: BCN Commercial |
$1,150.78
|
| Rate for Payer: Cash Price |
$3,461.55
|
| Rate for Payer: Cash Price |
$3,461.55
|
| Rate for Payer: Cofinity Advantage |
$3,028.86
|
| Rate for Payer: Cofinity Commercial |
$3,721.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,461.55
|
| Rate for Payer: Healthscope Commercial |
$3,894.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,461.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,677.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,245.20
|
| Rate for Payer: PHP Commercial |
$3,677.90
|
| Rate for Payer: Priority Health SBD |
$2,725.97
|
|
|
HC TRANS CATH REPAIR MITRAL VALVE INITIAL
|
Facility
|
OP
|
$18,306.49
|
|
|
Service Code
|
CPT 33418
|
| Hospital Charge Code |
48100154
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,868.74 |
| Max. Negotiated Rate |
$16,475.84 |
| Rate for Payer: Aetna Commercial |
$15,560.52
|
| Rate for Payer: Aetna Medicare |
$9,153.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,899.22
|
| Rate for Payer: BCBS Complete |
$7,322.60
|
| Rate for Payer: BCBS Trust/PPO |
$4,868.74
|
| Rate for Payer: BCN Commercial |
$4,868.74
|
| Rate for Payer: Cash Price |
$14,645.19
|
| Rate for Payer: Cash Price |
$14,645.19
|
| Rate for Payer: Cofinity Advantage |
$12,814.54
|
| Rate for Payer: Cofinity Commercial |
$15,743.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,645.19
|
| Rate for Payer: Healthscope Commercial |
$16,475.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,645.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,560.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,729.87
|
| Rate for Payer: PHP Commercial |
$15,560.52
|
| Rate for Payer: Priority Health SBD |
$11,533.09
|
|
|
HC TRANS CATH REPAIR MITRAL VALVE INITIAL
|
Facility
|
IP
|
$18,306.49
|
|
|
Service Code
|
CPT 33418
|
| Hospital Charge Code |
48100154
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,533.09 |
| Max. Negotiated Rate |
$16,475.84 |
| Rate for Payer: Aetna Commercial |
$15,560.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,899.22
|
| Rate for Payer: Cash Price |
$14,645.19
|
| Rate for Payer: Cofinity Advantage |
$12,814.54
|
| Rate for Payer: Cofinity Commercial |
$15,743.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,645.19
|
| Rate for Payer: Healthscope Commercial |
$16,475.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,560.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,729.87
|
| Rate for Payer: PHP Commercial |
$15,560.52
|
| Rate for Payer: Priority Health SBD |
$11,533.09
|
|
|
HC TRANS CATH RMVL/DEBULK ICAR MASS SUCTION DEVICE PERQ
|
Facility
|
OP
|
$16,324.08
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
36000125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,965.99 |
| Max. Negotiated Rate |
$18,339.80 |
| Rate for Payer: Aetna Commercial |
$13,875.47
|
| Rate for Payer: Aetna Medicare |
$5,897.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,610.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,088.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,088.88
|
| Rate for Payer: BCBS Complete |
$3,114.57
|
| Rate for Payer: BCBS MAPPO |
$5,671.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,406.85
|
| Rate for Payer: BCN Commercial |
$3,406.85
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.10
|
| Rate for Payer: Cash Price |
$13,059.26
|
| Rate for Payer: Cash Price |
$13,059.26
|
| Rate for Payer: Cash Price |
$13,059.26
|
| Rate for Payer: Cofinity Advantage |
$11,426.86
|
| Rate for Payer: Cofinity Commercial |
$14,038.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,059.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.10
|
| Rate for Payer: Healthscope Commercial |
$14,691.67
|
| Rate for Payer: Mclaren Medicaid |
$2,965.99
|
| Rate for Payer: Mclaren Medicare |
$5,671.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,954.65
|
| Rate for Payer: Meridian Medicaid |
$5,954.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,521.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,238.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,875.47
|
| Rate for Payer: Nomi Health Commercial |
$17,013.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,243.06
|
| Rate for Payer: PACE Medicare |
$5,387.55
|
| Rate for Payer: PACE SWMI |
$5,671.10
|
| Rate for Payer: PHP Commercial |
$13,875.47
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,965.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,339.80
|
| Rate for Payer: Priority Health Medicare |
$5,671.10
|
| Rate for Payer: Priority Health SBD |
$10,284.17
|
| Rate for Payer: Priority Health Tiered Network |
$14,671.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,671.10
|
| Rate for Payer: UHC Medicaid |
$2,965.99
|
| Rate for Payer: UHCCP Medicaid |
$2,965.99
|
| Rate for Payer: VA VA |
$5,671.10
|
|
|
HC TRANS CATH RMVL/DEBULK ICAR MASS SUCTION DEVICE PERQ
|
Facility
|
IP
|
$16,324.08
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
36000125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,284.17 |
| Max. Negotiated Rate |
$14,691.67 |
| Rate for Payer: Aetna Commercial |
$13,875.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,610.65
|
| Rate for Payer: Cash Price |
$13,059.26
|
| Rate for Payer: Cofinity Advantage |
$11,426.86
|
| Rate for Payer: Cofinity Commercial |
$14,038.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,059.26
|
| Rate for Payer: Healthscope Commercial |
$14,691.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,875.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,243.06
|
| Rate for Payer: PHP Commercial |
$13,875.47
|
| Rate for Payer: Priority Health SBD |
$10,284.17
|
|
|
HC TRANSCERVICAL AMNIOINFUSION
|
Facility
|
OP
|
$574.63
|
|
| Hospital Charge Code |
27000647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$225.83 |
| Max. Negotiated Rate |
$517.17 |
| Rate for Payer: Aetna Commercial |
$488.44
|
| Rate for Payer: Aetna Medicare |
$287.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.51
|
| Rate for Payer: BCBS Complete |
$229.85
|
| Rate for Payer: Cash Price |
$459.70
|
| Rate for Payer: Cofinity Advantage |
$402.24
|
| Rate for Payer: Cofinity Commercial |
$494.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.70
|
| Rate for Payer: Healthscope Commercial |
$517.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$459.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$488.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.97
|
| Rate for Payer: PHP Commercial |
$488.44
|
| Rate for Payer: Priority Health SBD |
$362.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.51
|
| Rate for Payer: UHC Core |
$299.38
|
| Rate for Payer: UHC Exchange |
$225.83
|
|
|
HC TRANSCERVICAL AMNIOINFUSION
|
Facility
|
IP
|
$574.63
|
|
| Hospital Charge Code |
27000647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$362.02 |
| Max. Negotiated Rate |
$517.17 |
| Rate for Payer: Aetna Commercial |
$488.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.51
|
| Rate for Payer: Cash Price |
$459.70
|
| Rate for Payer: Cofinity Advantage |
$402.24
|
| Rate for Payer: Cofinity Commercial |
$494.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.70
|
| Rate for Payer: Healthscope Commercial |
$517.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$488.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.97
|
| Rate for Payer: PHP Commercial |
$488.44
|
| Rate for Payer: Priority Health SBD |
$362.02
|
|
|
HC TRANSCRANIAL USN IMAGING COMPL
|
Facility
|
IP
|
$1,650.64
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,039.90 |
| Max. Negotiated Rate |
$1,485.58 |
| Rate for Payer: Aetna Commercial |
$1,403.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,072.92
|
| Rate for Payer: Cash Price |
$1,320.51
|
| Rate for Payer: Cofinity Advantage |
$1,155.45
|
| Rate for Payer: Cofinity Commercial |
$1,419.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.51
|
| Rate for Payer: Healthscope Commercial |
$1,485.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,403.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.98
|
| Rate for Payer: PHP Commercial |
$1,403.04
|
| Rate for Payer: Priority Health SBD |
$1,039.90
|
|
