|
HC LC/CABG'S W INTERVENTION
|
Facility
|
OP
|
$10,797.39
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,584.36 |
| Max. Negotiated Rate |
$10,797.39 |
| Rate for Payer: Aetna Commercial |
$9,717.65
|
| Rate for Payer: Aetna Medicare |
$2,896.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,620.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,620.58
|
| Rate for Payer: ASR ASR |
$10,473.47
|
| Rate for Payer: BCBS Complete |
$1,663.73
|
| Rate for Payer: BCBS MAPPO |
$2,896.46
|
| Rate for Payer: BCBS Trust/PPO |
$8,371.22
|
| Rate for Payer: BCN Commercial |
$8,371.22
|
| Rate for Payer: BCN Medicare Advantage |
$2,896.46
|
| Rate for Payer: Cash Price |
$8,637.91
|
| Rate for Payer: Cash Price |
$8,637.91
|
| Rate for Payer: Cofinity Commercial |
$10,149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,637.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,896.46
|
| Rate for Payer: Healthscope Commercial |
$10,797.39
|
| Rate for Payer: Healthscope Whirlpool |
$10,473.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,896.46
|
| Rate for Payer: Mclaren Commercial |
$9,717.65
|
| Rate for Payer: Mclaren Medicaid |
$1,584.36
|
| Rate for Payer: Mclaren Medicare |
$2,896.46
|
| Rate for Payer: Meridian Medicaid |
$1,663.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,041.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,330.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,177.78
|
| Rate for Payer: PACE Medicare |
$2,751.64
|
| Rate for Payer: PACE SWMI |
$2,896.46
|
| Rate for Payer: PHP Commercial |
$3,186.11
|
| Rate for Payer: PHP Medicaid |
$1,584.36
|
| Rate for Payer: PHP Medicare Advantage |
$2,896.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,584.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,558.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,825.62
|
| Rate for Payer: Priority Health Medicare |
$2,896.46
|
| Rate for Payer: Priority Health Narrow Network |
$7,666.15
|
| Rate for Payer: Railroad Medicare Medicare |
$2,896.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,501.70
|
| Rate for Payer: UHC Medicare Advantage |
$2,983.35
|
| Rate for Payer: VA VA |
$2,896.46
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
OP
|
$58.60
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$88.77 |
| Rate for Payer: Aetna Commercial |
$52.74
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.12
|
| Rate for Payer: ASR ASR |
$56.84
|
| Rate for Payer: BCBS Complete |
$6.03
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$45.43
|
| Rate for Payer: BCN Commercial |
$45.43
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$58.60
|
| Rate for Payer: Healthscope Whirlpool |
$56.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.50
|
| Rate for Payer: Mclaren Commercial |
$52.74
|
| Rate for Payer: Mclaren Medicaid |
$5.74
|
| Rate for Payer: Mclaren Medicare |
$10.50
|
| Rate for Payer: Meridian Medicaid |
$6.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.81
|
| Rate for Payer: PACE Medicare |
$9.98
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$11.55
|
| Rate for Payer: PHP Medicaid |
$5.74
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.77
|
| Rate for Payer: Priority Health Medicare |
$10.50
|
| Rate for Payer: Priority Health Narrow Network |
$71.02
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.57
|
| Rate for Payer: UHC Medicare Advantage |
$10.82
|
| Rate for Payer: VA VA |
$10.50
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
IP
|
$58.60
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.02 |
| Max. Negotiated Rate |
$58.60 |
| Rate for Payer: Aetna Commercial |
$52.74
|
| Rate for Payer: ASR ASR |
$56.84
|
| Rate for Payer: BCBS Trust/PPO |
$45.43
|
| Rate for Payer: BCN Commercial |
$45.43
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$58.60
|
| Rate for Payer: Healthscope Whirlpool |
$56.84
|
| Rate for Payer: Mclaren Commercial |
$52.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.57
|
|
|
HC L&D MEDICAL EMERGENCY VISIT
|
Facility
|
IP
|
$860.74
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.52 |
| Max. Negotiated Rate |
$860.74 |
| Rate for Payer: Aetna Commercial |
$774.67
|
| Rate for Payer: ASR ASR |
$834.92
|
| Rate for Payer: BCBS Trust/PPO |
$667.33
|
| Rate for Payer: BCN Commercial |
$667.33
|
| Rate for Payer: Cash Price |
$688.59
|
| Rate for Payer: Cofinity Commercial |
$809.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.59
|
| Rate for Payer: Healthscope Commercial |
$860.74
|
| Rate for Payer: Healthscope Whirlpool |
$834.92
|
| Rate for Payer: Mclaren Commercial |
$774.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.45
|
|
|
HC L&D MEDICAL EMERGENCY VISIT
|
Facility
|
OP
|
$860.74
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.72 |
| Max. Negotiated Rate |
$860.74 |
| Rate for Payer: Aetna Commercial |
$774.67
|
| Rate for Payer: Aetna Medicare |
$253.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$317.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$317.01
|
| Rate for Payer: ASR ASR |
$834.92
|
| Rate for Payer: BCBS Complete |
$145.67
|
| Rate for Payer: BCBS MAPPO |
$253.61
|
| Rate for Payer: BCBS Trust/PPO |
$667.33
|
| Rate for Payer: BCN Commercial |
$667.33
|
| Rate for Payer: BCN Medicare Advantage |
$253.61
|
| Rate for Payer: Cash Price |
$688.59
|
| Rate for Payer: Cash Price |
$688.59
|
| Rate for Payer: Cofinity Commercial |
$809.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.61
|
| Rate for Payer: Healthscope Commercial |
$860.74
|
| Rate for Payer: Healthscope Whirlpool |
$834.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$253.61
|
| Rate for Payer: Mclaren Commercial |
$774.67
|
| Rate for Payer: Mclaren Medicaid |
$138.72
|
| Rate for Payer: Mclaren Medicare |
$253.61
|
| Rate for Payer: Meridian Medicaid |
$145.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$266.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.63
|
| Rate for Payer: PACE Medicare |
$240.93
|
| Rate for Payer: PACE SWMI |
$253.61
|
| Rate for Payer: PHP Commercial |
$278.97
|
| Rate for Payer: PHP Medicaid |
$138.72
|
| Rate for Payer: PHP Medicare Advantage |
$253.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.41
|
| Rate for Payer: Priority Health Medicare |
$253.61
|
| Rate for Payer: Priority Health Narrow Network |
$357.93
|
| Rate for Payer: Railroad Medicare Medicare |
$253.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.45
|
| Rate for Payer: UHC Medicare Advantage |
$261.22
|
| Rate for Payer: VA VA |
$253.61
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
IP
|
$1,441.05
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,008.74 |
| Max. Negotiated Rate |
$1,441.05 |
| Rate for Payer: Aetna Commercial |
$1,296.94
|
| Rate for Payer: ASR ASR |
$1,397.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.25
|
| Rate for Payer: BCN Commercial |
$1,117.25
|
| Rate for Payer: Cash Price |
$1,152.84
|
| Rate for Payer: Cofinity Commercial |
$1,354.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.84
|
| Rate for Payer: Healthscope Commercial |
$1,441.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,397.82
|
| Rate for Payer: Mclaren Commercial |
$1,296.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,268.12
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
OP
|
$1,441.05
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$576.42 |
| Max. Negotiated Rate |
$1,441.05 |
| Rate for Payer: Aetna Commercial |
$1,296.94
|
| Rate for Payer: ASR ASR |
$1,397.82
|
| Rate for Payer: BCBS Complete |
$576.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.25
|
| Rate for Payer: BCN Commercial |
$1,117.25
|
| Rate for Payer: Cash Price |
$1,152.84
|
| Rate for Payer: Cofinity Commercial |
$1,354.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.84
|
| Rate for Payer: Healthscope Commercial |
$1,441.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,397.82
|
| Rate for Payer: Mclaren Commercial |
$1,296.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,311.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,023.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,268.12
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
IP
|
$3,602.41
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,521.69 |
| Max. Negotiated Rate |
$3,602.41 |
| Rate for Payer: Aetna Commercial |
$3,242.17
|
| Rate for Payer: ASR ASR |
$3,494.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,792.95
|
| Rate for Payer: BCN Commercial |
$2,792.95
|
| Rate for Payer: Cash Price |
$2,881.93
|
| Rate for Payer: Cofinity Commercial |
$3,386.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,881.93
|
| Rate for Payer: Healthscope Commercial |
$3,602.41
|
| Rate for Payer: Healthscope Whirlpool |
$3,494.34
|
| Rate for Payer: Mclaren Commercial |
$3,242.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,062.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,170.12
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
OP
|
$3,602.41
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,440.96 |
| Max. Negotiated Rate |
$3,602.41 |
| Rate for Payer: Aetna Commercial |
$3,242.17
|
| Rate for Payer: ASR ASR |
$3,494.34
|
| Rate for Payer: BCBS Complete |
$1,440.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,792.95
|
| Rate for Payer: BCN Commercial |
$2,792.95
|
| Rate for Payer: Cash Price |
$2,881.93
|
| Rate for Payer: Cofinity Commercial |
$3,386.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,881.93
|
| Rate for Payer: Healthscope Commercial |
$3,602.41
|
| Rate for Payer: Healthscope Whirlpool |
$3,494.34
|
| Rate for Payer: Mclaren Commercial |
$3,242.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,062.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,278.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,557.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,170.12
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
IP
|
$2,881.83
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,017.28 |
| Max. Negotiated Rate |
$2,881.83 |
| Rate for Payer: Aetna Commercial |
$2,593.65
|
| Rate for Payer: ASR ASR |
$2,795.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,234.28
|
| Rate for Payer: BCN Commercial |
$2,234.28
|
| Rate for Payer: Cash Price |
$2,305.46
|
| Rate for Payer: Cofinity Commercial |
$2,708.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,305.46
|
| Rate for Payer: Healthscope Commercial |
$2,881.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,795.38
|
| Rate for Payer: Mclaren Commercial |
$2,593.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,449.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,536.01
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
OP
|
$2,881.83
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,152.73 |
| Max. Negotiated Rate |
$2,881.83 |
| Rate for Payer: Aetna Commercial |
$2,593.65
|
| Rate for Payer: ASR ASR |
$2,795.38
|
| Rate for Payer: BCBS Complete |
$1,152.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,234.28
|
| Rate for Payer: BCN Commercial |
$2,234.28
|
| Rate for Payer: Cash Price |
$2,305.46
|
| Rate for Payer: Cofinity Commercial |
$2,708.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,305.46
|
| Rate for Payer: Healthscope Commercial |
$2,881.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,795.38
|
| Rate for Payer: Mclaren Commercial |
$2,593.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,449.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,622.47
|
| Rate for Payer: Priority Health Narrow Network |
$2,046.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,536.01
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
IP
|
$3,202.09
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,241.46 |
| Max. Negotiated Rate |
$3,202.09 |
| Rate for Payer: Aetna Commercial |
$2,881.88
|
| Rate for Payer: ASR ASR |
$3,106.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,482.58
|
| Rate for Payer: BCN Commercial |
$2,482.58
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$3,009.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,561.67
|
| Rate for Payer: Healthscope Commercial |
$3,202.09
|
| Rate for Payer: Healthscope Whirlpool |
$3,106.03
|
| Rate for Payer: Mclaren Commercial |
$2,881.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,817.84
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
OP
|
$3,202.09
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,280.84 |
| Max. Negotiated Rate |
$3,202.09 |
| Rate for Payer: Aetna Commercial |
$2,881.88
|
| Rate for Payer: ASR ASR |
$3,106.03
|
| Rate for Payer: BCBS Complete |
$1,280.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,482.58
|
| Rate for Payer: BCN Commercial |
$2,482.58
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$3,009.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,561.67
|
| Rate for Payer: Healthscope Commercial |
$3,202.09
|
| Rate for Payer: Healthscope Whirlpool |
$3,106.03
|
| Rate for Payer: Mclaren Commercial |
$2,881.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,913.90
|
| Rate for Payer: Priority Health Narrow Network |
$2,273.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,817.84
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
OP
|
$1,188.59
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$475.44 |
| Max. Negotiated Rate |
$1,188.59 |
| Rate for Payer: Aetna Commercial |
$1,069.73
|
| Rate for Payer: ASR ASR |
$1,152.93
|
| Rate for Payer: BCBS Complete |
$475.44
|
| Rate for Payer: BCBS Trust/PPO |
$921.51
|
| Rate for Payer: BCN Commercial |
$921.51
|
| Rate for Payer: Cash Price |
$950.87
|
| Rate for Payer: Cofinity Commercial |
$1,117.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.87
|
| Rate for Payer: Healthscope Commercial |
$1,188.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,152.93
|
| Rate for Payer: Mclaren Commercial |
$1,069.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,081.62
|
| Rate for Payer: Priority Health Narrow Network |
$843.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,045.96
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
IP
|
$1,188.59
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$832.01 |
| Max. Negotiated Rate |
$1,188.59 |
| Rate for Payer: Aetna Commercial |
$1,069.73
|
| Rate for Payer: ASR ASR |
$1,152.93
|
| Rate for Payer: BCBS Trust/PPO |
$921.51
|
| Rate for Payer: BCN Commercial |
$921.51
|
| Rate for Payer: Cash Price |
$950.87
|
| Rate for Payer: Cofinity Commercial |
$1,117.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.87
|
| Rate for Payer: Healthscope Commercial |
$1,188.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,152.93
|
| Rate for Payer: Mclaren Commercial |
$1,069.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,045.96
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
OP
|
$1,427.13
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$570.85 |
| Max. Negotiated Rate |
$1,427.13 |
| Rate for Payer: Aetna Commercial |
$1,284.42
|
| Rate for Payer: ASR ASR |
$1,384.32
|
| Rate for Payer: BCBS Complete |
$570.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,106.45
|
| Rate for Payer: BCN Commercial |
$1,106.45
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: Cofinity Commercial |
$1,341.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,141.70
|
| Rate for Payer: Healthscope Commercial |
$1,427.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,384.32
|
| Rate for Payer: Mclaren Commercial |
$1,284.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,213.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$998.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,298.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,255.87
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
IP
|
$1,427.13
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$998.99 |
| Max. Negotiated Rate |
$1,427.13 |
| Rate for Payer: Aetna Commercial |
$1,284.42
|
| Rate for Payer: ASR ASR |
$1,384.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,106.45
|
| Rate for Payer: BCN Commercial |
$1,106.45
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: Cofinity Commercial |
$1,341.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,141.70
|
| Rate for Payer: Healthscope Commercial |
$1,427.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,384.32
|
| Rate for Payer: Mclaren Commercial |
$1,284.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,213.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$998.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,255.87
|
|
|
HC LEAD
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Medicare |
$12.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.14
|
| Rate for Payer: ASR ASR |
$42.68
|
| Rate for Payer: BCBS Complete |
$6.96
|
| Rate for Payer: BCBS MAPPO |
$12.11
|
| Rate for Payer: BCBS Trust/PPO |
$34.11
|
| Rate for Payer: BCN Commercial |
$34.11
|
| Rate for Payer: BCN Medicare Advantage |
$12.11
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$41.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$44.00
|
| Rate for Payer: Healthscope Whirlpool |
$42.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.11
|
| Rate for Payer: Mclaren Commercial |
$39.60
|
| Rate for Payer: Mclaren Medicaid |
$6.62
|
| Rate for Payer: Mclaren Medicare |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.40
|
| Rate for Payer: PACE Medicare |
$11.50
|
| Rate for Payer: PACE SWMI |
$12.11
|
| Rate for Payer: PHP Commercial |
$13.32
|
| Rate for Payer: PHP Medicaid |
$6.62
|
| Rate for Payer: PHP Medicare Advantage |
$12.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.99
|
| Rate for Payer: Priority Health Medicare |
$12.11
|
| Rate for Payer: Priority Health Narrow Network |
$31.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.72
|
| Rate for Payer: UHC Medicare Advantage |
$12.47
|
| Rate for Payer: VA VA |
$12.11
|
|
|
HC LEAD
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: ASR ASR |
$42.68
|
| Rate for Payer: BCBS Trust/PPO |
$34.11
|
| Rate for Payer: BCN Commercial |
$34.11
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$41.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.20
|
| Rate for Payer: Healthscope Commercial |
$44.00
|
| Rate for Payer: Healthscope Whirlpool |
$42.68
|
| Rate for Payer: Mclaren Commercial |
$39.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.72
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
OP
|
$14,450.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,780.00 |
| Max. Negotiated Rate |
$14,450.00 |
| Rate for Payer: Aetna Commercial |
$13,005.00
|
| Rate for Payer: ASR ASR |
$14,016.50
|
| Rate for Payer: BCBS Complete |
$5,780.00
|
| Rate for Payer: BCBS Trust/PPO |
$11,203.08
|
| Rate for Payer: BCN Commercial |
$11,203.08
|
| Rate for Payer: Cash Price |
$11,560.00
|
| Rate for Payer: Cofinity Commercial |
$13,583.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,560.00
|
| Rate for Payer: Healthscope Commercial |
$14,450.00
|
| Rate for Payer: Healthscope Whirlpool |
$14,016.50
|
| Rate for Payer: Mclaren Commercial |
$13,005.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,282.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,115.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,149.50
|
| Rate for Payer: Priority Health Narrow Network |
$10,259.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,716.00
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
IP
|
$14,450.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,115.00 |
| Max. Negotiated Rate |
$14,450.00 |
| Rate for Payer: Aetna Commercial |
$13,005.00
|
| Rate for Payer: ASR ASR |
$14,016.50
|
| Rate for Payer: BCBS Trust/PPO |
$11,203.08
|
| Rate for Payer: BCN Commercial |
$11,203.08
|
| Rate for Payer: Cash Price |
$11,560.00
|
| Rate for Payer: Cofinity Commercial |
$13,583.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,560.00
|
| Rate for Payer: Healthscope Commercial |
$14,450.00
|
| Rate for Payer: Healthscope Whirlpool |
$14,016.50
|
| Rate for Payer: Mclaren Commercial |
$13,005.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,282.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,115.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,716.00
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
OP
|
$2,040.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$1,836.00
|
| Rate for Payer: ASR ASR |
$1,978.80
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,581.61
|
| Rate for Payer: BCN Commercial |
$1,581.61
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cofinity Commercial |
$1,917.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,632.00
|
| Rate for Payer: Healthscope Commercial |
$2,040.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,978.80
|
| Rate for Payer: Mclaren Commercial |
$1,836.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,856.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,448.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,795.20
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
IP
|
$2,040.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$1,836.00
|
| Rate for Payer: ASR ASR |
$1,978.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,581.61
|
| Rate for Payer: BCN Commercial |
$1,581.61
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cofinity Commercial |
$1,917.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,632.00
|
| Rate for Payer: Healthscope Commercial |
$2,040.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,978.80
|
| Rate for Payer: Mclaren Commercial |
$1,836.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,795.20
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
OP
|
$7,656.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,062.40 |
| Max. Negotiated Rate |
$7,656.00 |
| Rate for Payer: Aetna Commercial |
$6,890.40
|
| Rate for Payer: ASR ASR |
$7,426.32
|
| Rate for Payer: BCBS Complete |
$3,062.40
|
| Rate for Payer: BCBS Trust/PPO |
$5,935.70
|
| Rate for Payer: BCN Commercial |
$5,935.70
|
| Rate for Payer: Cash Price |
$6,124.80
|
| Rate for Payer: Cofinity Commercial |
$7,196.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,124.80
|
| Rate for Payer: Healthscope Commercial |
$7,656.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,426.32
|
| Rate for Payer: Mclaren Commercial |
$6,890.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,507.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,359.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,966.96
|
| Rate for Payer: Priority Health Narrow Network |
$5,435.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,737.28
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
IP
|
$7,656.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,359.20 |
| Max. Negotiated Rate |
$7,656.00 |
| Rate for Payer: Aetna Commercial |
$6,890.40
|
| Rate for Payer: ASR ASR |
$7,426.32
|
| Rate for Payer: BCBS Trust/PPO |
$5,935.70
|
| Rate for Payer: BCN Commercial |
$5,935.70
|
| Rate for Payer: Cash Price |
$6,124.80
|
| Rate for Payer: Cofinity Commercial |
$7,196.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,124.80
|
| Rate for Payer: Healthscope Commercial |
$7,656.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,426.32
|
| Rate for Payer: Mclaren Commercial |
$6,890.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,507.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,359.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,737.28
|
|
