|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: ASR ASR |
$52.38
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$41.87
|
| Rate for Payer: BCN Commercial |
$41.87
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$50.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.20
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Healthscope Whirlpool |
$52.38
|
| Rate for Payer: Mclaren Commercial |
$48.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.14
|
| Rate for Payer: Priority Health Narrow Network |
$38.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.52
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
IP
|
$1,440.03
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,008.02 |
| Max. Negotiated Rate |
$1,440.03 |
| Rate for Payer: Aetna Commercial |
$1,296.03
|
| Rate for Payer: ASR ASR |
$1,396.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.46
|
| Rate for Payer: BCN Commercial |
$1,116.46
|
| Rate for Payer: Cash Price |
$1,152.02
|
| Rate for Payer: Cofinity Commercial |
$1,353.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.02
|
| Rate for Payer: Healthscope Commercial |
$1,440.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,396.83
|
| Rate for Payer: Mclaren Commercial |
$1,296.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,267.23
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
OP
|
$1,440.03
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$576.01 |
| Max. Negotiated Rate |
$1,440.03 |
| Rate for Payer: Aetna Commercial |
$1,296.03
|
| Rate for Payer: ASR ASR |
$1,396.83
|
| Rate for Payer: BCBS Complete |
$576.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.46
|
| Rate for Payer: BCN Commercial |
$1,116.46
|
| Rate for Payer: Cash Price |
$1,152.02
|
| Rate for Payer: Cofinity Commercial |
$1,353.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.02
|
| Rate for Payer: Healthscope Commercial |
$1,440.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,396.83
|
| Rate for Payer: Mclaren Commercial |
$1,296.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,310.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,022.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,267.23
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
IP
|
$1,215.00
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$850.50 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$1,093.50
|
| Rate for Payer: ASR ASR |
$1,178.55
|
| Rate for Payer: BCBS Trust/PPO |
$941.99
|
| Rate for Payer: BCN Commercial |
$941.99
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cofinity Commercial |
$1,142.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.00
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,178.55
|
| Rate for Payer: Mclaren Commercial |
$1,093.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,032.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,069.20
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
OP
|
$1,215.00
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$1,093.50
|
| Rate for Payer: ASR ASR |
$1,178.55
|
| Rate for Payer: BCBS Complete |
$486.00
|
| Rate for Payer: BCBS Trust/PPO |
$941.99
|
| Rate for Payer: BCN Commercial |
$941.99
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cofinity Commercial |
$1,142.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.00
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,178.55
|
| Rate for Payer: Mclaren Commercial |
$1,093.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,032.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,105.65
|
| Rate for Payer: Priority Health Narrow Network |
$862.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,069.20
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
OP
|
$1,230.00
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$492.00 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna Commercial |
$1,107.00
|
| Rate for Payer: ASR ASR |
$1,193.10
|
| Rate for Payer: BCBS Complete |
$492.00
|
| Rate for Payer: BCBS Trust/PPO |
$953.62
|
| Rate for Payer: BCN Commercial |
$953.62
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cofinity Commercial |
$1,156.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$984.00
|
| Rate for Payer: Healthscope Commercial |
$1,230.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,193.10
|
| Rate for Payer: Mclaren Commercial |
$1,107.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,045.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,119.30
|
| Rate for Payer: Priority Health Narrow Network |
$873.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,082.40
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
IP
|
$1,230.00
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$861.00 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna Commercial |
$1,107.00
|
| Rate for Payer: ASR ASR |
$1,193.10
|
| Rate for Payer: BCBS Trust/PPO |
$953.62
|
| Rate for Payer: BCN Commercial |
$953.62
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cofinity Commercial |
$1,156.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$984.00
|
| Rate for Payer: Healthscope Commercial |
$1,230.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,193.10
|
| Rate for Payer: Mclaren Commercial |
$1,107.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,045.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,082.40
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
IP
|
$3,787.50
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,651.25 |
| Max. Negotiated Rate |
$3,787.50 |
| Rate for Payer: Aetna Commercial |
$3,408.75
|
| Rate for Payer: ASR ASR |
$3,673.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,936.45
|
| Rate for Payer: BCN Commercial |
$2,936.45
|
| Rate for Payer: Cash Price |
$3,030.00
|
| Rate for Payer: Cofinity Commercial |
$3,560.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,030.00
|
| Rate for Payer: Healthscope Commercial |
$3,787.50
|
| Rate for Payer: Healthscope Whirlpool |
$3,673.88
|
| Rate for Payer: Mclaren Commercial |
$3,408.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,219.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,333.00
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
OP
|
$3,787.50
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,515.00 |
| Max. Negotiated Rate |
$3,787.50 |
| Rate for Payer: Aetna Commercial |
$3,408.75
|
| Rate for Payer: ASR ASR |
$3,673.88
|
| Rate for Payer: BCBS Complete |
$1,515.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,936.45
|
| Rate for Payer: BCN Commercial |
$2,936.45
|
| Rate for Payer: Cash Price |
$3,030.00
|
| Rate for Payer: Cofinity Commercial |
$3,560.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,030.00
|
| Rate for Payer: Healthscope Commercial |
$3,787.50
|
| Rate for Payer: Healthscope Whirlpool |
$3,673.88
|
| Rate for Payer: Mclaren Commercial |
$3,408.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,219.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,446.62
|
| Rate for Payer: Priority Health Narrow Network |
$2,689.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,333.00
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
IP
|
$786.48
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$550.54 |
| Max. Negotiated Rate |
$786.48 |
| Rate for Payer: Aetna Commercial |
$707.83
|
| Rate for Payer: ASR ASR |
$762.89
|
| Rate for Payer: BCBS Trust/PPO |
$609.76
|
| Rate for Payer: BCN Commercial |
$609.76
|
| Rate for Payer: Cash Price |
$629.18
|
| Rate for Payer: Cofinity Commercial |
$739.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.18
|
| Rate for Payer: Healthscope Commercial |
$786.48
|
| Rate for Payer: Healthscope Whirlpool |
$762.89
|
| Rate for Payer: Mclaren Commercial |
$707.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$668.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$692.10
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
OP
|
$786.48
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$786.48 |
| Rate for Payer: Aetna Commercial |
$707.83
|
| Rate for Payer: Aetna Medicare |
$177.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: ASR ASR |
$762.89
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$609.76
|
| Rate for Payer: BCN Commercial |
$609.76
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Cash Price |
$629.18
|
| Rate for Payer: Cash Price |
$629.18
|
| Rate for Payer: Cofinity Commercial |
$739.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Healthscope Commercial |
$786.48
|
| Rate for Payer: Healthscope Whirlpool |
$762.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.12
|
| Rate for Payer: Mclaren Commercial |
$707.83
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$668.51
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Commercial |
$194.83
|
| Rate for Payer: PHP Medicaid |
$96.88
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.90
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$184.72
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$692.10
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$177.12
|
|
|
HC OYSTER IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC OYSTER IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
IP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,566.40 |
| Max. Negotiated Rate |
$7,952.00 |
| Rate for Payer: Aetna Commercial |
$7,156.80
|
| Rate for Payer: ASR ASR |
$7,713.44
|
| Rate for Payer: BCBS Trust/PPO |
$6,165.19
|
| Rate for Payer: BCN Commercial |
$6,165.19
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$7,474.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,952.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,713.44
|
| Rate for Payer: Mclaren Commercial |
$7,156.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,566.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,997.76
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
OP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,180.80 |
| Max. Negotiated Rate |
$7,952.00 |
| Rate for Payer: Aetna Commercial |
$7,156.80
|
| Rate for Payer: ASR ASR |
$7,713.44
|
| Rate for Payer: BCBS Complete |
$3,180.80
|
| Rate for Payer: BCBS Trust/PPO |
$6,165.19
|
| Rate for Payer: BCN Commercial |
$6,165.19
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$7,474.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,952.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,713.44
|
| Rate for Payer: Mclaren Commercial |
$7,156.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,566.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,236.32
|
| Rate for Payer: Priority Health Narrow Network |
$5,645.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,997.76
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
IP
|
$9,052.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,336.40 |
| Max. Negotiated Rate |
$9,052.00 |
| Rate for Payer: Aetna Commercial |
$8,146.80
|
| Rate for Payer: ASR ASR |
$8,780.44
|
| Rate for Payer: BCBS Trust/PPO |
$7,018.02
|
| Rate for Payer: BCN Commercial |
$7,018.02
|
| Rate for Payer: Cash Price |
$7,241.60
|
| Rate for Payer: Cofinity Commercial |
$8,508.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,241.60
|
| Rate for Payer: Healthscope Commercial |
$9,052.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,780.44
|
| Rate for Payer: Mclaren Commercial |
$8,146.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,694.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,336.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,965.76
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
OP
|
$9,052.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,620.80 |
| Max. Negotiated Rate |
$9,052.00 |
| Rate for Payer: Aetna Commercial |
$8,146.80
|
| Rate for Payer: ASR ASR |
$8,780.44
|
| Rate for Payer: BCBS Complete |
$3,620.80
|
| Rate for Payer: BCBS Trust/PPO |
$7,018.02
|
| Rate for Payer: BCN Commercial |
$7,018.02
|
| Rate for Payer: Cash Price |
$7,241.60
|
| Rate for Payer: Cofinity Commercial |
$8,508.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,241.60
|
| Rate for Payer: Healthscope Commercial |
$9,052.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,780.44
|
| Rate for Payer: Mclaren Commercial |
$8,146.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,694.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,336.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,237.32
|
| Rate for Payer: Priority Health Narrow Network |
$6,426.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,965.76
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
IP
|
$17,588.23
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,311.76 |
| Max. Negotiated Rate |
$17,588.23 |
| Rate for Payer: Aetna Commercial |
$15,829.41
|
| Rate for Payer: ASR ASR |
$17,060.58
|
| Rate for Payer: BCBS Trust/PPO |
$13,636.15
|
| Rate for Payer: BCN Commercial |
$13,636.15
|
| Rate for Payer: Cash Price |
$14,070.58
|
| Rate for Payer: Cofinity Commercial |
$16,532.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,070.58
|
| Rate for Payer: Healthscope Commercial |
$17,588.23
|
| Rate for Payer: Healthscope Whirlpool |
$17,060.58
|
| Rate for Payer: Mclaren Commercial |
$15,829.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,950.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,311.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,477.64
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
OP
|
$17,588.23
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,191.95 |
| Max. Negotiated Rate |
$17,588.23 |
| Rate for Payer: Aetna Commercial |
$15,829.41
|
| Rate for Payer: Aetna Medicare |
$9,491.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,864.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,864.60
|
| Rate for Payer: ASR ASR |
$17,060.58
|
| Rate for Payer: BCBS Complete |
$5,452.02
|
| Rate for Payer: BCBS MAPPO |
$9,491.68
|
| Rate for Payer: BCBS Trust/PPO |
$13,636.15
|
| Rate for Payer: BCN Commercial |
$13,636.15
|
| Rate for Payer: BCN Medicare Advantage |
$9,491.68
|
| Rate for Payer: Cash Price |
$14,070.58
|
| Rate for Payer: Cash Price |
$14,070.58
|
| Rate for Payer: Cofinity Commercial |
$16,532.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,070.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,491.68
|
| Rate for Payer: Healthscope Commercial |
$17,588.23
|
| Rate for Payer: Healthscope Whirlpool |
$17,060.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,491.68
|
| Rate for Payer: Mclaren Commercial |
$15,829.41
|
| Rate for Payer: Mclaren Medicaid |
$5,191.95
|
| Rate for Payer: Mclaren Medicare |
$9,491.68
|
| Rate for Payer: Meridian Medicaid |
$5,452.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,966.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,915.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,950.00
|
| Rate for Payer: PACE Medicare |
$9,017.10
|
| Rate for Payer: PACE SWMI |
$9,491.68
|
| Rate for Payer: PHP Commercial |
$10,440.85
|
| Rate for Payer: PHP Medicaid |
$5,191.95
|
| Rate for Payer: PHP Medicare Advantage |
$9,491.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,191.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,311.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,005.29
|
| Rate for Payer: Priority Health Medicare |
$9,491.68
|
| Rate for Payer: Priority Health Narrow Network |
$12,487.64
|
| Rate for Payer: Railroad Medicare Medicare |
$9,491.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,477.64
|
| Rate for Payer: UHC Medicare Advantage |
$9,776.43
|
| Rate for Payer: VA VA |
$9,491.68
|
|
|
HC PACEMAKER LEAD
|
Facility
|
OP
|
$1,911.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$764.40 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna Commercial |
$1,719.90
|
| Rate for Payer: ASR ASR |
$1,853.67
|
| Rate for Payer: BCBS Complete |
$764.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,481.60
|
| Rate for Payer: BCN Commercial |
$1,481.60
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$1,796.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.80
|
| Rate for Payer: Healthscope Commercial |
$1,911.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,853.67
|
| Rate for Payer: Mclaren Commercial |
$1,719.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,624.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,337.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,739.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,356.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,681.68
|
|
|
HC PACEMAKER LEAD
|
Facility
|
IP
|
$1,911.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,337.70 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna Commercial |
$1,719.90
|
| Rate for Payer: ASR ASR |
$1,853.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,481.60
|
| Rate for Payer: BCN Commercial |
$1,481.60
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$1,796.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.80
|
| Rate for Payer: Healthscope Commercial |
$1,911.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,853.67
|
| Rate for Payer: Mclaren Commercial |
$1,719.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,624.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,337.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,681.68
|
|
|
HC PACEMAKER OTHER SINGLE OR DUAL LVL 11
|
Facility
|
OP
|
$11,889.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,755.60 |
| Max. Negotiated Rate |
$11,889.00 |
| Rate for Payer: Aetna Commercial |
$10,700.10
|
| Rate for Payer: ASR ASR |
$11,532.33
|
| Rate for Payer: BCBS Complete |
$4,755.60
|
| Rate for Payer: BCBS Trust/PPO |
$9,217.54
|
| Rate for Payer: BCN Commercial |
$9,217.54
|
| Rate for Payer: Cash Price |
$9,511.20
|
| Rate for Payer: Cofinity Commercial |
$11,175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,511.20
|
| Rate for Payer: Healthscope Commercial |
$11,889.00
|
| Rate for Payer: Healthscope Whirlpool |
$11,532.33
|
| Rate for Payer: Mclaren Commercial |
$10,700.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,322.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,818.99
|
| Rate for Payer: Priority Health Narrow Network |
$8,441.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,462.32
|
|
|
HC PACEMAKER OTHER SINGLE OR DUAL LVL 11
|
Facility
|
IP
|
$11,889.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,322.30 |
| Max. Negotiated Rate |
$11,889.00 |
| Rate for Payer: Aetna Commercial |
$10,700.10
|
| Rate for Payer: ASR ASR |
$11,532.33
|
| Rate for Payer: BCBS Trust/PPO |
$9,217.54
|
| Rate for Payer: BCN Commercial |
$9,217.54
|
| Rate for Payer: Cash Price |
$9,511.20
|
| Rate for Payer: Cofinity Commercial |
$11,175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,511.20
|
| Rate for Payer: Healthscope Commercial |
$11,889.00
|
| Rate for Payer: Healthscope Whirlpool |
$11,532.33
|
| Rate for Payer: Mclaren Commercial |
$10,700.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,322.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,462.32
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 13
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500351
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,400.00 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: Aetna Commercial |
$12,150.00
|
| Rate for Payer: ASR ASR |
$13,095.00
|
| Rate for Payer: BCBS Complete |
$5,400.00
|
| Rate for Payer: BCBS Trust/PPO |
$10,466.55
|
| Rate for Payer: BCN Commercial |
$10,466.55
|
| Rate for Payer: Cash Price |
$10,800.00
|
| Rate for Payer: Cofinity Commercial |
$12,690.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,800.00
|
| Rate for Payer: Healthscope Commercial |
$13,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,095.00
|
| Rate for Payer: Mclaren Commercial |
$12,150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,475.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,450.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,285.00
|
| Rate for Payer: Priority Health Narrow Network |
$9,585.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,880.00
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 13
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500351
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,450.00 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: Aetna Commercial |
$12,150.00
|
| Rate for Payer: ASR ASR |
$13,095.00
|
| Rate for Payer: BCBS Trust/PPO |
$10,466.55
|
| Rate for Payer: BCN Commercial |
$10,466.55
|
| Rate for Payer: Cash Price |
$10,800.00
|
| Rate for Payer: Cofinity Commercial |
$12,690.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,800.00
|
| Rate for Payer: Healthscope Commercial |
$13,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,095.00
|
| Rate for Payer: Mclaren Commercial |
$12,150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,475.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,450.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,880.00
|
|
