|
HC PACEMAKER SINGLE CHAMBER LVL 16
|
Facility
|
OP
|
$16,532.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,613.00 |
| Max. Negotiated Rate |
$16,532.50 |
| Rate for Payer: Aetna Commercial |
$14,879.25
|
| Rate for Payer: ASR ASR |
$16,036.52
|
| Rate for Payer: BCBS Complete |
$6,613.00
|
| Rate for Payer: BCBS Trust/PPO |
$12,817.65
|
| Rate for Payer: BCN Commercial |
$12,817.65
|
| Rate for Payer: Cash Price |
$13,226.00
|
| Rate for Payer: Cofinity Commercial |
$15,540.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,226.00
|
| Rate for Payer: Healthscope Commercial |
$16,532.50
|
| Rate for Payer: Healthscope Whirlpool |
$16,036.52
|
| Rate for Payer: Mclaren Commercial |
$14,879.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,052.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,572.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,044.58
|
| Rate for Payer: Priority Health Narrow Network |
$11,738.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,548.60
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 16
|
Facility
|
IP
|
$16,532.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,572.75 |
| Max. Negotiated Rate |
$16,532.50 |
| Rate for Payer: Aetna Commercial |
$14,879.25
|
| Rate for Payer: ASR ASR |
$16,036.52
|
| Rate for Payer: BCBS Trust/PPO |
$12,817.65
|
| Rate for Payer: BCN Commercial |
$12,817.65
|
| Rate for Payer: Cash Price |
$13,226.00
|
| Rate for Payer: Cofinity Commercial |
$15,540.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,226.00
|
| Rate for Payer: Healthscope Commercial |
$16,532.50
|
| Rate for Payer: Healthscope Whirlpool |
$16,036.52
|
| Rate for Payer: Mclaren Commercial |
$14,879.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,052.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,572.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,548.60
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
OP
|
$6,196.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,478.40 |
| Max. Negotiated Rate |
$6,196.00 |
| Rate for Payer: Aetna Commercial |
$5,576.40
|
| Rate for Payer: ASR ASR |
$6,010.12
|
| Rate for Payer: BCBS Complete |
$2,478.40
|
| Rate for Payer: BCBS Trust/PPO |
$4,803.76
|
| Rate for Payer: BCN Commercial |
$4,803.76
|
| Rate for Payer: Cash Price |
$4,956.80
|
| Rate for Payer: Cofinity Commercial |
$5,824.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,956.80
|
| Rate for Payer: Healthscope Commercial |
$6,196.00
|
| Rate for Payer: Healthscope Whirlpool |
$6,010.12
|
| Rate for Payer: Mclaren Commercial |
$5,576.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,266.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,337.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,638.36
|
| Rate for Payer: Priority Health Narrow Network |
$4,399.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,452.48
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
IP
|
$6,196.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,337.20 |
| Max. Negotiated Rate |
$6,196.00 |
| Rate for Payer: Aetna Commercial |
$5,576.40
|
| Rate for Payer: ASR ASR |
$6,010.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,803.76
|
| Rate for Payer: BCN Commercial |
$4,803.76
|
| Rate for Payer: Cash Price |
$4,956.80
|
| Rate for Payer: Cofinity Commercial |
$5,824.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,956.80
|
| Rate for Payer: Healthscope Commercial |
$6,196.00
|
| Rate for Payer: Healthscope Whirlpool |
$6,010.12
|
| Rate for Payer: Mclaren Commercial |
$5,576.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,266.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,337.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,452.48
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
OP
|
$8,152.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,260.80 |
| Max. Negotiated Rate |
$8,152.00 |
| Rate for Payer: Aetna Commercial |
$7,336.80
|
| Rate for Payer: ASR ASR |
$7,907.44
|
| Rate for Payer: BCBS Complete |
$3,260.80
|
| Rate for Payer: BCBS Trust/PPO |
$6,320.25
|
| Rate for Payer: BCN Commercial |
$6,320.25
|
| Rate for Payer: Cash Price |
$6,521.60
|
| Rate for Payer: Cofinity Commercial |
$7,662.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,521.60
|
| Rate for Payer: Healthscope Commercial |
$8,152.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,907.44
|
| Rate for Payer: Mclaren Commercial |
$7,336.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,929.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,706.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,418.32
|
| Rate for Payer: Priority Health Narrow Network |
$5,787.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,173.76
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
IP
|
$8,152.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,706.40 |
| Max. Negotiated Rate |
$8,152.00 |
| Rate for Payer: Aetna Commercial |
$7,336.80
|
| Rate for Payer: ASR ASR |
$7,907.44
|
| Rate for Payer: BCBS Trust/PPO |
$6,320.25
|
| Rate for Payer: BCN Commercial |
$6,320.25
|
| Rate for Payer: Cash Price |
$6,521.60
|
| Rate for Payer: Cofinity Commercial |
$7,662.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,521.60
|
| Rate for Payer: Healthscope Commercial |
$8,152.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,907.44
|
| Rate for Payer: Mclaren Commercial |
$7,336.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,929.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,706.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,173.76
|
|
|
HC PACEMAKER TESTING CABLE
|
Facility
|
IP
|
$112.44
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.71 |
| Max. Negotiated Rate |
$112.44 |
| Rate for Payer: Aetna Commercial |
$101.20
|
| Rate for Payer: ASR ASR |
$109.07
|
| Rate for Payer: BCBS Trust/PPO |
$87.17
|
| Rate for Payer: BCN Commercial |
$87.17
|
| Rate for Payer: Cash Price |
$89.95
|
| Rate for Payer: Cofinity Commercial |
$105.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.95
|
| Rate for Payer: Healthscope Commercial |
$112.44
|
| Rate for Payer: Healthscope Whirlpool |
$109.07
|
| Rate for Payer: Mclaren Commercial |
$101.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.95
|
|
|
HC PACEMAKER TESTING CABLE
|
Facility
|
OP
|
$112.44
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$112.44 |
| Rate for Payer: Aetna Commercial |
$101.20
|
| Rate for Payer: ASR ASR |
$109.07
|
| Rate for Payer: BCBS Complete |
$44.98
|
| Rate for Payer: BCBS Trust/PPO |
$87.17
|
| Rate for Payer: BCN Commercial |
$87.17
|
| Rate for Payer: Cash Price |
$89.95
|
| Rate for Payer: Cofinity Commercial |
$105.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.95
|
| Rate for Payer: Healthscope Commercial |
$112.44
|
| Rate for Payer: Healthscope Whirlpool |
$109.07
|
| Rate for Payer: Mclaren Commercial |
$101.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.32
|
| Rate for Payer: Priority Health Narrow Network |
$79.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.95
|
|
|
HC PACER POCKET REVISION
|
Facility
|
IP
|
$2,701.70
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,891.19 |
| Max. Negotiated Rate |
$2,701.70 |
| Rate for Payer: Aetna Commercial |
$2,431.53
|
| Rate for Payer: ASR ASR |
$2,620.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,094.63
|
| Rate for Payer: BCN Commercial |
$2,094.63
|
| Rate for Payer: Cash Price |
$2,161.36
|
| Rate for Payer: Cofinity Commercial |
$2,539.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,161.36
|
| Rate for Payer: Healthscope Commercial |
$2,701.70
|
| Rate for Payer: Healthscope Whirlpool |
$2,620.65
|
| Rate for Payer: Mclaren Commercial |
$2,431.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,296.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,891.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,377.50
|
|
|
HC PACER POCKET REVISION
|
Facility
|
OP
|
$2,701.70
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$2,701.70 |
| Rate for Payer: Aetna Commercial |
$2,431.53
|
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: ASR ASR |
$2,620.65
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,094.63
|
| Rate for Payer: BCN Commercial |
$2,094.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$2,161.36
|
| Rate for Payer: Cash Price |
$2,161.36
|
| Rate for Payer: Cofinity Commercial |
$2,539.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,161.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$2,701.70
|
| Rate for Payer: Healthscope Whirlpool |
$2,620.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$2,431.53
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,296.44
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,891.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,458.55
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,918.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,377.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: ASR ASR |
$727.50
|
| Rate for Payer: BCBS Trust/PPO |
$581.48
|
| Rate for Payer: BCN Commercial |
$581.48
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$705.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.00
|
| Rate for Payer: Healthscope Commercial |
$750.00
|
| Rate for Payer: Healthscope Whirlpool |
$727.50
|
| Rate for Payer: Mclaren Commercial |
$675.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$637.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.00
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: ASR ASR |
$727.50
|
| Rate for Payer: BCBS Complete |
$300.00
|
| Rate for Payer: BCBS Trust/PPO |
$581.48
|
| Rate for Payer: BCN Commercial |
$581.48
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$705.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.00
|
| Rate for Payer: Healthscope Commercial |
$750.00
|
| Rate for Payer: Healthscope Whirlpool |
$727.50
|
| Rate for Payer: Mclaren Commercial |
$675.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$637.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.50
|
| Rate for Payer: Priority Health Narrow Network |
$532.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.00
|
|
|
HC PACKED CELLS DIRECT
|
Facility
|
IP
|
$809.10
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$566.37 |
| Max. Negotiated Rate |
$809.10 |
| Rate for Payer: Aetna Commercial |
$728.19
|
| Rate for Payer: ASR ASR |
$784.83
|
| Rate for Payer: BCBS Trust/PPO |
$627.30
|
| Rate for Payer: BCN Commercial |
$627.30
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cofinity Commercial |
$760.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.28
|
| Rate for Payer: Healthscope Commercial |
$809.10
|
| Rate for Payer: Healthscope Whirlpool |
$784.83
|
| Rate for Payer: Mclaren Commercial |
$728.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$712.01
|
|
|
HC PACKED CELLS DIRECT
|
Facility
|
OP
|
$809.10
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$809.10 |
| Rate for Payer: Aetna Commercial |
$728.19
|
| Rate for Payer: Aetna Medicare |
$168.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.86
|
| Rate for Payer: ASR ASR |
$784.83
|
| Rate for Payer: BCBS Complete |
$96.90
|
| Rate for Payer: BCBS MAPPO |
$168.69
|
| Rate for Payer: BCBS Trust/PPO |
$627.30
|
| Rate for Payer: BCN Commercial |
$627.30
|
| Rate for Payer: BCN Medicare Advantage |
$168.69
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cofinity Commercial |
$760.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.69
|
| Rate for Payer: Healthscope Commercial |
$809.10
|
| Rate for Payer: Healthscope Whirlpool |
$784.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$168.69
|
| Rate for Payer: Mclaren Commercial |
$728.19
|
| Rate for Payer: Mclaren Medicaid |
$92.27
|
| Rate for Payer: Mclaren Medicare |
$168.69
|
| Rate for Payer: Meridian Medicaid |
$96.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.74
|
| Rate for Payer: PACE Medicare |
$160.26
|
| Rate for Payer: PACE SWMI |
$168.69
|
| Rate for Payer: PHP Commercial |
$185.56
|
| Rate for Payer: PHP Medicaid |
$92.27
|
| Rate for Payer: PHP Medicare Advantage |
$168.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.52
|
| Rate for Payer: Priority Health Medicare |
$168.69
|
| Rate for Payer: Priority Health Narrow Network |
$235.62
|
| Rate for Payer: Railroad Medicare Medicare |
$168.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$712.01
|
| Rate for Payer: UHC Medicare Advantage |
$173.75
|
| Rate for Payer: VA VA |
$168.69
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
IP
|
$1,232.44
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$862.71 |
| Max. Negotiated Rate |
$1,232.44 |
| Rate for Payer: Aetna Commercial |
$1,109.20
|
| Rate for Payer: ASR ASR |
$1,195.47
|
| Rate for Payer: BCBS Trust/PPO |
$955.51
|
| Rate for Payer: BCN Commercial |
$955.51
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cofinity Commercial |
$1,158.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$985.95
|
| Rate for Payer: Healthscope Commercial |
$1,232.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,195.47
|
| Rate for Payer: Mclaren Commercial |
$1,109.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,047.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,084.55
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
OP
|
$1,232.44
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$128.84 |
| Max. Negotiated Rate |
$1,232.44 |
| Rate for Payer: Aetna Commercial |
$1,109.20
|
| Rate for Payer: Aetna Medicare |
$235.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.42
|
| Rate for Payer: ASR ASR |
$1,195.47
|
| Rate for Payer: BCBS Complete |
$135.29
|
| Rate for Payer: BCBS MAPPO |
$235.54
|
| Rate for Payer: BCBS Trust/PPO |
$955.51
|
| Rate for Payer: BCN Commercial |
$955.51
|
| Rate for Payer: BCN Medicare Advantage |
$235.54
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cofinity Commercial |
$1,158.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$985.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.54
|
| Rate for Payer: Healthscope Commercial |
$1,232.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,195.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.54
|
| Rate for Payer: Mclaren Commercial |
$1,109.20
|
| Rate for Payer: Mclaren Medicaid |
$128.84
|
| Rate for Payer: Mclaren Medicare |
$235.54
|
| Rate for Payer: Meridian Medicaid |
$135.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$247.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,047.57
|
| Rate for Payer: PACE Medicare |
$223.76
|
| Rate for Payer: PACE SWMI |
$235.54
|
| Rate for Payer: PHP Commercial |
$259.09
|
| Rate for Payer: PHP Medicaid |
$128.84
|
| Rate for Payer: PHP Medicare Advantage |
$235.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$508.99
|
| Rate for Payer: Priority Health Medicare |
$235.54
|
| Rate for Payer: Priority Health Narrow Network |
$407.19
|
| Rate for Payer: Railroad Medicare Medicare |
$235.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,084.55
|
| Rate for Payer: UHC Medicare Advantage |
$242.61
|
| Rate for Payer: VA VA |
$235.54
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
OP
|
$96.00
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: ASR ASR |
$93.12
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: BCBS Trust/PPO |
$74.43
|
| Rate for Payer: BCN Commercial |
$74.43
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$90.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.80
|
| Rate for Payer: Healthscope Commercial |
$96.00
|
| Rate for Payer: Healthscope Whirlpool |
$93.12
|
| Rate for Payer: Mclaren Commercial |
$86.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.36
|
| Rate for Payer: Priority Health Narrow Network |
$68.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.48
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
IP
|
$96.00
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: ASR ASR |
$93.12
|
| Rate for Payer: BCBS Trust/PPO |
$74.43
|
| Rate for Payer: BCN Commercial |
$74.43
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$90.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.80
|
| Rate for Payer: Healthscope Commercial |
$96.00
|
| Rate for Payer: Healthscope Whirlpool |
$93.12
|
| Rate for Payer: Mclaren Commercial |
$86.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.48
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: ASR ASR |
$654.75
|
| Rate for Payer: BCBS Trust/PPO |
$523.33
|
| Rate for Payer: BCN Commercial |
$523.33
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$634.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Healthscope Commercial |
$675.00
|
| Rate for Payer: Healthscope Whirlpool |
$654.75
|
| Rate for Payer: Mclaren Commercial |
$607.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.00
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: ASR ASR |
$654.75
|
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: BCBS Trust/PPO |
$523.33
|
| Rate for Payer: BCN Commercial |
$523.33
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$634.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Healthscope Commercial |
$675.00
|
| Rate for Payer: Healthscope Whirlpool |
$654.75
|
| Rate for Payer: Mclaren Commercial |
$607.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.25
|
| Rate for Payer: Priority Health Narrow Network |
$479.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.00
|
|
|
HC PACK TABLE LINE
|
Facility
|
OP
|
$201.00
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: ASR ASR |
$194.97
|
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: BCBS Trust/PPO |
$155.84
|
| Rate for Payer: BCN Commercial |
$155.84
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$188.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.80
|
| Rate for Payer: Healthscope Commercial |
$201.00
|
| Rate for Payer: Healthscope Whirlpool |
$194.97
|
| Rate for Payer: Mclaren Commercial |
$180.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.91
|
| Rate for Payer: Priority Health Narrow Network |
$142.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.88
|
|
|
HC PACK TABLE LINE
|
Facility
|
IP
|
$201.00
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.70 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: ASR ASR |
$194.97
|
| Rate for Payer: BCBS Trust/PPO |
$155.84
|
| Rate for Payer: BCN Commercial |
$155.84
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$188.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.80
|
| Rate for Payer: Healthscope Commercial |
$201.00
|
| Rate for Payer: Healthscope Whirlpool |
$194.97
|
| Rate for Payer: Mclaren Commercial |
$180.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.88
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$742.50
|
| Rate for Payer: ASR ASR |
$800.25
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: BCBS Trust/PPO |
$639.62
|
| Rate for Payer: BCN Commercial |
$639.62
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$775.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.00
|
| Rate for Payer: Healthscope Commercial |
$825.00
|
| Rate for Payer: Healthscope Whirlpool |
$800.25
|
| Rate for Payer: Mclaren Commercial |
$742.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$750.75
|
| Rate for Payer: Priority Health Narrow Network |
$585.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.00
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$742.50
|
| Rate for Payer: ASR ASR |
$800.25
|
| Rate for Payer: BCBS Trust/PPO |
$639.62
|
| Rate for Payer: BCN Commercial |
$639.62
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$775.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.00
|
| Rate for Payer: Healthscope Commercial |
$825.00
|
| Rate for Payer: Healthscope Whirlpool |
$800.25
|
| Rate for Payer: Mclaren Commercial |
$742.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.00
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
OP
|
$161.16
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$161.16 |
| Rate for Payer: Aetna Commercial |
$145.04
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$156.33
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$124.95
|
| Rate for Payer: BCN Commercial |
$124.95
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cofinity Commercial |
$151.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$161.16
|
| Rate for Payer: Healthscope Whirlpool |
$156.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$145.04
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.99
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.66
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$114.42
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.82
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
