|
HC LAYR CLOS WND REST BODY <2.5 CM
|
Facility
|
IP
|
$498.64
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
76100228
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.12 |
| Max. Negotiated Rate |
$498.64 |
| Rate for Payer: Aetna Commercial |
$448.78
|
| Rate for Payer: ASR ASR |
$483.68
|
| Rate for Payer: ASR Commercial |
$483.68
|
| Rate for Payer: BCBS Trust/PPO |
$406.34
|
| Rate for Payer: BCN Commercial |
$386.60
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$468.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Healthscope Commercial |
$498.64
|
| Rate for Payer: Healthscope Whirlpool |
$483.68
|
| Rate for Payer: Mclaren Commercial |
$448.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: Nomi Health Commercial |
$408.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.80
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
OP
|
$11,013.34
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.13 |
| Max. Negotiated Rate |
$11,013.34 |
| Rate for Payer: Aetna Commercial |
$9,912.01
|
| Rate for Payer: Aetna Medicare |
$3,151.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,939.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,939.21
|
| Rate for Payer: ASR ASR |
$10,682.94
|
| Rate for Payer: ASR Commercial |
$10,682.94
|
| Rate for Payer: BCBS Complete |
$1,773.59
|
| Rate for Payer: BCBS MAPPO |
$3,151.37
|
| Rate for Payer: BCBS Trust/PPO |
$9,018.82
|
| Rate for Payer: BCN Commercial |
$8,538.64
|
| Rate for Payer: BCN Medicare Advantage |
$3,151.37
|
| Rate for Payer: Cash Price |
$8,810.67
|
| Rate for Payer: Cash Price |
$8,810.67
|
| Rate for Payer: Cofinity Commercial |
$10,352.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,810.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,151.37
|
| Rate for Payer: Healthscope Commercial |
$11,013.34
|
| Rate for Payer: Healthscope Whirlpool |
$10,682.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,151.37
|
| Rate for Payer: Mclaren Commercial |
$9,912.01
|
| Rate for Payer: Mclaren Medicaid |
$1,689.13
|
| Rate for Payer: Mclaren Medicare |
$3,151.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,308.94
|
| Rate for Payer: Meridian Medicaid |
$1,773.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,624.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,361.34
|
| Rate for Payer: Nomi Health Commercial |
$9,030.94
|
| Rate for Payer: PACE Medicare |
$2,993.80
|
| Rate for Payer: PACE SWMI |
$3,151.37
|
| Rate for Payer: PHP Commercial |
$3,466.51
|
| Rate for Payer: PHP Medicaid |
$1,689.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,151.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,689.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,158.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,649.89
|
| Rate for Payer: Priority Health Medicare |
$3,151.37
|
| Rate for Payer: Priority Health Narrow Network |
$7,720.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3,151.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,691.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,151.37
|
| Rate for Payer: UHC Exchange |
$4,884.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,151.37
|
| Rate for Payer: UHCCP DNSP |
$3,151.37
|
| Rate for Payer: UHCCP Medicaid |
$1,689.13
|
| Rate for Payer: VA VA |
$3,151.37
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
IP
|
$11,013.34
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,158.67 |
| Max. Negotiated Rate |
$11,013.34 |
| Rate for Payer: Aetna Commercial |
$9,912.01
|
| Rate for Payer: ASR ASR |
$10,682.94
|
| Rate for Payer: ASR Commercial |
$10,682.94
|
| Rate for Payer: BCBS Trust/PPO |
$8,974.77
|
| Rate for Payer: BCN Commercial |
$8,538.64
|
| Rate for Payer: Cash Price |
$8,810.67
|
| Rate for Payer: Cofinity Commercial |
$10,352.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,810.67
|
| Rate for Payer: Healthscope Commercial |
$11,013.34
|
| Rate for Payer: Healthscope Whirlpool |
$10,682.94
|
| Rate for Payer: Mclaren Commercial |
$9,912.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,361.34
|
| Rate for Payer: Nomi Health Commercial |
$9,030.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,158.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,691.74
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
OP
|
$59.77
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$94.98 |
| Rate for Payer: Aetna Commercial |
$53.79
|
| 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 |
$57.98
|
| Rate for Payer: ASR Commercial |
$57.98
|
| Rate for Payer: BCBS Complete |
$5.91
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$48.95
|
| Rate for Payer: BCN Commercial |
$46.34
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$47.82
|
| Rate for Payer: Cash Price |
$47.82
|
| Rate for Payer: Cofinity Commercial |
$56.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$59.77
|
| Rate for Payer: Healthscope Whirlpool |
$57.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.50
|
| Rate for Payer: Mclaren Commercial |
$53.79
|
| Rate for Payer: Mclaren Medicaid |
$5.63
|
| Rate for Payer: Mclaren Medicare |
$10.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.02
|
| Rate for Payer: Meridian Medicaid |
$5.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.80
|
| Rate for Payer: Nomi Health Commercial |
$49.01
|
| 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 |
$5.63
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.98
|
| Rate for Payer: Priority Health Medicare |
$10.50
|
| Rate for Payer: Priority Health Narrow Network |
$75.98
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.50
|
| Rate for Payer: UHC Exchange |
$16.28
|
| Rate for Payer: UHC Medicare Advantage |
$10.50
|
| Rate for Payer: UHCCP DNSP |
$10.50
|
| Rate for Payer: UHCCP Medicaid |
$5.63
|
| Rate for Payer: VA VA |
$10.50
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
IP
|
$59.77
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Aetna Commercial |
$53.79
|
| Rate for Payer: ASR ASR |
$57.98
|
| Rate for Payer: ASR Commercial |
$57.98
|
| Rate for Payer: BCBS Trust/PPO |
$48.71
|
| Rate for Payer: BCN Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$47.82
|
| Rate for Payer: Cofinity Commercial |
$56.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.82
|
| Rate for Payer: Healthscope Commercial |
$59.77
|
| Rate for Payer: Healthscope Whirlpool |
$57.98
|
| Rate for Payer: Mclaren Commercial |
$53.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.80
|
| Rate for Payer: Nomi Health Commercial |
$49.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.60
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
IP
|
$1,469.87
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$955.42 |
| Max. Negotiated Rate |
$1,469.87 |
| Rate for Payer: Aetna Commercial |
$1,322.88
|
| Rate for Payer: ASR ASR |
$1,425.77
|
| Rate for Payer: ASR Commercial |
$1,425.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.80
|
| Rate for Payer: BCN Commercial |
$1,139.59
|
| Rate for Payer: Cash Price |
$1,175.90
|
| Rate for Payer: Cofinity Commercial |
$1,381.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.90
|
| Rate for Payer: Healthscope Commercial |
$1,469.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.77
|
| Rate for Payer: Mclaren Commercial |
$1,322.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.39
|
| Rate for Payer: Nomi Health Commercial |
$1,205.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,293.49
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
OP
|
$1,469.87
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$587.95 |
| Max. Negotiated Rate |
$1,469.87 |
| Rate for Payer: Aetna Commercial |
$1,322.88
|
| Rate for Payer: Aetna Medicare |
$734.94
|
| Rate for Payer: ASR ASR |
$1,425.77
|
| Rate for Payer: ASR Commercial |
$1,425.77
|
| Rate for Payer: BCBS Complete |
$587.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.68
|
| Rate for Payer: BCN Commercial |
$1,139.59
|
| Rate for Payer: Cash Price |
$1,175.90
|
| Rate for Payer: Cofinity Commercial |
$1,381.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.90
|
| Rate for Payer: Healthscope Commercial |
$1,469.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.77
|
| Rate for Payer: Mclaren Commercial |
$1,322.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.39
|
| Rate for Payer: Nomi Health Commercial |
$1,205.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,287.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,030.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,293.49
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
OP
|
$3,674.46
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,469.78 |
| Max. Negotiated Rate |
$3,674.46 |
| Rate for Payer: Aetna Commercial |
$3,307.01
|
| Rate for Payer: Aetna Medicare |
$1,837.23
|
| Rate for Payer: ASR ASR |
$3,564.23
|
| Rate for Payer: ASR Commercial |
$3,564.23
|
| Rate for Payer: BCBS Complete |
$1,469.78
|
| Rate for Payer: BCBS Trust/PPO |
$3,009.02
|
| Rate for Payer: BCN Commercial |
$2,848.81
|
| Rate for Payer: Cash Price |
$2,939.57
|
| Rate for Payer: Cofinity Commercial |
$3,453.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,939.57
|
| Rate for Payer: Healthscope Commercial |
$3,674.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,564.23
|
| Rate for Payer: Mclaren Commercial |
$3,307.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,123.29
|
| Rate for Payer: Nomi Health Commercial |
$3,013.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,388.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,219.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,575.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,233.52
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
IP
|
$3,674.46
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,388.40 |
| Max. Negotiated Rate |
$3,674.46 |
| Rate for Payer: Aetna Commercial |
$3,307.01
|
| Rate for Payer: ASR ASR |
$3,564.23
|
| Rate for Payer: ASR Commercial |
$3,564.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,994.32
|
| Rate for Payer: BCN Commercial |
$2,848.81
|
| Rate for Payer: Cash Price |
$2,939.57
|
| Rate for Payer: Cofinity Commercial |
$3,453.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,939.57
|
| Rate for Payer: Healthscope Commercial |
$3,674.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,564.23
|
| Rate for Payer: Mclaren Commercial |
$3,307.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,123.29
|
| Rate for Payer: Nomi Health Commercial |
$3,013.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,388.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,233.52
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
IP
|
$2,939.47
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,910.66 |
| Max. Negotiated Rate |
$2,939.47 |
| Rate for Payer: Aetna Commercial |
$2,645.52
|
| Rate for Payer: ASR ASR |
$2,851.29
|
| Rate for Payer: ASR Commercial |
$2,851.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,395.37
|
| Rate for Payer: BCN Commercial |
$2,278.97
|
| Rate for Payer: Cash Price |
$2,351.58
|
| Rate for Payer: Cofinity Commercial |
$2,763.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,351.58
|
| Rate for Payer: Healthscope Commercial |
$2,939.47
|
| Rate for Payer: Healthscope Whirlpool |
$2,851.29
|
| Rate for Payer: Mclaren Commercial |
$2,645.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,498.55
|
| Rate for Payer: Nomi Health Commercial |
$2,410.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,910.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,586.73
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
OP
|
$2,939.47
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,175.79 |
| Max. Negotiated Rate |
$2,939.47 |
| Rate for Payer: Aetna Commercial |
$2,645.52
|
| Rate for Payer: Aetna Medicare |
$1,469.74
|
| Rate for Payer: ASR ASR |
$2,851.29
|
| Rate for Payer: ASR Commercial |
$2,851.29
|
| Rate for Payer: BCBS Complete |
$1,175.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,407.13
|
| Rate for Payer: BCN Commercial |
$2,278.97
|
| Rate for Payer: Cash Price |
$2,351.58
|
| Rate for Payer: Cofinity Commercial |
$2,763.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,351.58
|
| Rate for Payer: Healthscope Commercial |
$2,939.47
|
| Rate for Payer: Healthscope Whirlpool |
$2,851.29
|
| Rate for Payer: Mclaren Commercial |
$2,645.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,498.55
|
| Rate for Payer: Nomi Health Commercial |
$2,410.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,910.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,575.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,060.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,586.73
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
IP
|
$3,266.13
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,122.98 |
| Max. Negotiated Rate |
$3,266.13 |
| Rate for Payer: Aetna Commercial |
$2,939.52
|
| Rate for Payer: ASR ASR |
$3,168.15
|
| Rate for Payer: ASR Commercial |
$3,168.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,661.57
|
| Rate for Payer: BCN Commercial |
$2,532.23
|
| Rate for Payer: Cash Price |
$2,612.90
|
| Rate for Payer: Cofinity Commercial |
$3,070.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,612.90
|
| Rate for Payer: Healthscope Commercial |
$3,266.13
|
| Rate for Payer: Healthscope Whirlpool |
$3,168.15
|
| Rate for Payer: Mclaren Commercial |
$2,939.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,776.21
|
| Rate for Payer: Nomi Health Commercial |
$2,678.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,122.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,874.19
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
OP
|
$3,266.13
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,306.45 |
| Max. Negotiated Rate |
$3,266.13 |
| Rate for Payer: Aetna Commercial |
$2,939.52
|
| Rate for Payer: Aetna Medicare |
$1,633.06
|
| Rate for Payer: ASR ASR |
$3,168.15
|
| Rate for Payer: ASR Commercial |
$3,168.15
|
| Rate for Payer: BCBS Complete |
$1,306.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,674.63
|
| Rate for Payer: BCN Commercial |
$2,532.23
|
| Rate for Payer: Cash Price |
$2,612.90
|
| Rate for Payer: Cofinity Commercial |
$3,070.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,612.90
|
| Rate for Payer: Healthscope Commercial |
$3,266.13
|
| Rate for Payer: Healthscope Whirlpool |
$3,168.15
|
| Rate for Payer: Mclaren Commercial |
$2,939.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,776.21
|
| Rate for Payer: Nomi Health Commercial |
$2,678.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,122.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,861.78
|
| Rate for Payer: Priority Health Narrow Network |
$2,289.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,874.19
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
OP
|
$1,212.36
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$484.94 |
| Max. Negotiated Rate |
$1,212.36 |
| Rate for Payer: Aetna Commercial |
$1,091.12
|
| Rate for Payer: Aetna Medicare |
$606.18
|
| Rate for Payer: ASR ASR |
$1,175.99
|
| Rate for Payer: ASR Commercial |
$1,175.99
|
| Rate for Payer: BCBS Complete |
$484.94
|
| Rate for Payer: BCBS Trust/PPO |
$992.80
|
| Rate for Payer: BCN Commercial |
$939.94
|
| Rate for Payer: Cash Price |
$969.89
|
| Rate for Payer: Cofinity Commercial |
$1,139.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.89
|
| Rate for Payer: Healthscope Commercial |
$1,212.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,175.99
|
| Rate for Payer: Mclaren Commercial |
$1,091.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.51
|
| Rate for Payer: Nomi Health Commercial |
$994.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,062.27
|
| Rate for Payer: Priority Health Narrow Network |
$849.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,066.88
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
IP
|
$1,212.36
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$788.03 |
| Max. Negotiated Rate |
$1,212.36 |
| Rate for Payer: Aetna Commercial |
$1,091.12
|
| Rate for Payer: ASR ASR |
$1,175.99
|
| Rate for Payer: ASR Commercial |
$1,175.99
|
| Rate for Payer: BCBS Trust/PPO |
$987.95
|
| Rate for Payer: BCN Commercial |
$939.94
|
| Rate for Payer: Cash Price |
$969.89
|
| Rate for Payer: Cofinity Commercial |
$1,139.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.89
|
| Rate for Payer: Healthscope Commercial |
$1,212.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,175.99
|
| Rate for Payer: Mclaren Commercial |
$1,091.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.51
|
| Rate for Payer: Nomi Health Commercial |
$994.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,066.88
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
OP
|
$1,455.67
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$582.27 |
| Max. Negotiated Rate |
$1,455.67 |
| Rate for Payer: Aetna Commercial |
$1,310.10
|
| Rate for Payer: Aetna Medicare |
$727.84
|
| Rate for Payer: ASR ASR |
$1,412.00
|
| Rate for Payer: ASR Commercial |
$1,412.00
|
| Rate for Payer: BCBS Complete |
$582.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,192.05
|
| Rate for Payer: BCN Commercial |
$1,128.58
|
| Rate for Payer: Cash Price |
$1,164.54
|
| Rate for Payer: Cofinity Commercial |
$1,368.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,164.54
|
| Rate for Payer: Healthscope Commercial |
$1,455.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,412.00
|
| Rate for Payer: Mclaren Commercial |
$1,310.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,237.32
|
| Rate for Payer: Nomi Health Commercial |
$1,193.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$946.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,275.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,020.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,280.99
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
IP
|
$1,455.67
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$946.19 |
| Max. Negotiated Rate |
$1,455.67 |
| Rate for Payer: Aetna Commercial |
$1,310.10
|
| Rate for Payer: ASR ASR |
$1,412.00
|
| Rate for Payer: ASR Commercial |
$1,412.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.23
|
| Rate for Payer: BCN Commercial |
$1,128.58
|
| Rate for Payer: Cash Price |
$1,164.54
|
| Rate for Payer: Cofinity Commercial |
$1,368.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,164.54
|
| Rate for Payer: Healthscope Commercial |
$1,455.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,412.00
|
| Rate for Payer: Mclaren Commercial |
$1,310.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,237.32
|
| Rate for Payer: Nomi Health Commercial |
$1,193.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$946.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,280.99
|
|
|
HC LEAD
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$44.88 |
| Rate for Payer: Aetna Commercial |
$40.39
|
| 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 |
$43.53
|
| Rate for Payer: ASR Commercial |
$43.53
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS MAPPO |
$12.11
|
| Rate for Payer: BCBS Trust/PPO |
$36.75
|
| Rate for Payer: BCN Commercial |
$34.80
|
| Rate for Payer: BCN Medicare Advantage |
$12.11
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$42.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$44.88
|
| Rate for Payer: Healthscope Whirlpool |
$43.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.11
|
| Rate for Payer: Mclaren Commercial |
$40.39
|
| Rate for Payer: Mclaren Medicaid |
$6.49
|
| Rate for Payer: Mclaren Medicare |
$12.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.72
|
| Rate for Payer: Meridian Medicaid |
$6.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.15
|
| Rate for Payer: Nomi Health Commercial |
$36.80
|
| 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 |
$6.49
|
| Rate for Payer: PHP Medicare Advantage |
$12.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.72
|
| Rate for Payer: Priority Health Medicare |
$12.11
|
| Rate for Payer: Priority Health Narrow Network |
$33.38
|
| Rate for Payer: Railroad Medicare Medicare |
$12.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.11
|
| Rate for Payer: UHC Exchange |
$18.77
|
| Rate for Payer: UHC Medicare Advantage |
$12.11
|
| Rate for Payer: UHCCP DNSP |
$12.11
|
| Rate for Payer: UHCCP Medicaid |
$6.49
|
| Rate for Payer: VA VA |
$12.11
|
|
|
HC LEAD
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$44.88 |
| Rate for Payer: Aetna Commercial |
$40.39
|
| Rate for Payer: ASR ASR |
$43.53
|
| Rate for Payer: ASR Commercial |
$43.53
|
| Rate for Payer: BCBS Trust/PPO |
$36.57
|
| Rate for Payer: BCN Commercial |
$34.80
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$42.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Healthscope Commercial |
$44.88
|
| Rate for Payer: Healthscope Whirlpool |
$43.53
|
| Rate for Payer: Mclaren Commercial |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.15
|
| Rate for Payer: Nomi Health Commercial |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.49
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
IP
|
$14,739.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,580.35 |
| Max. Negotiated Rate |
$14,739.00 |
| Rate for Payer: Aetna Commercial |
$13,265.10
|
| Rate for Payer: ASR ASR |
$14,296.83
|
| Rate for Payer: ASR Commercial |
$14,296.83
|
| Rate for Payer: BCBS Trust/PPO |
$12,010.81
|
| Rate for Payer: BCN Commercial |
$11,427.15
|
| Rate for Payer: Cash Price |
$11,791.20
|
| Rate for Payer: Cofinity Commercial |
$13,854.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,791.20
|
| Rate for Payer: Healthscope Commercial |
$14,739.00
|
| Rate for Payer: Healthscope Whirlpool |
$14,296.83
|
| Rate for Payer: Mclaren Commercial |
$13,265.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,528.15
|
| Rate for Payer: Nomi Health Commercial |
$12,085.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,580.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,970.32
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
OP
|
$14,739.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,895.60 |
| Max. Negotiated Rate |
$14,739.00 |
| Rate for Payer: Aetna Commercial |
$13,265.10
|
| Rate for Payer: Aetna Medicare |
$7,369.50
|
| Rate for Payer: ASR ASR |
$14,296.83
|
| Rate for Payer: ASR Commercial |
$14,296.83
|
| Rate for Payer: BCBS Complete |
$5,895.60
|
| Rate for Payer: BCBS Trust/PPO |
$12,069.77
|
| Rate for Payer: BCN Commercial |
$11,427.15
|
| Rate for Payer: Cash Price |
$11,791.20
|
| Rate for Payer: Cofinity Commercial |
$13,854.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,791.20
|
| Rate for Payer: Healthscope Commercial |
$14,739.00
|
| Rate for Payer: Healthscope Whirlpool |
$14,296.83
|
| Rate for Payer: Mclaren Commercial |
$13,265.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,528.15
|
| Rate for Payer: Nomi Health Commercial |
$12,085.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,580.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,914.31
|
| Rate for Payer: Priority Health Narrow Network |
$10,332.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,970.32
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
OP
|
$2,080.80
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$832.32 |
| Max. Negotiated Rate |
$2,080.80 |
| Rate for Payer: Aetna Commercial |
$1,872.72
|
| Rate for Payer: Aetna Medicare |
$1,040.40
|
| Rate for Payer: ASR ASR |
$2,018.38
|
| Rate for Payer: ASR Commercial |
$2,018.38
|
| Rate for Payer: BCBS Complete |
$832.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.97
|
| Rate for Payer: BCN Commercial |
$1,613.24
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cofinity Commercial |
$1,955.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,664.64
|
| Rate for Payer: Healthscope Commercial |
$2,080.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,018.38
|
| Rate for Payer: Mclaren Commercial |
$1,872.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,768.68
|
| Rate for Payer: Nomi Health Commercial |
$1,706.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,352.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,823.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,458.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,831.10
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
IP
|
$2,080.80
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,352.52 |
| Max. Negotiated Rate |
$2,080.80 |
| Rate for Payer: Aetna Commercial |
$1,872.72
|
| Rate for Payer: ASR ASR |
$2,018.38
|
| Rate for Payer: ASR Commercial |
$2,018.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,695.64
|
| Rate for Payer: BCN Commercial |
$1,613.24
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cofinity Commercial |
$1,955.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,664.64
|
| Rate for Payer: Healthscope Commercial |
$2,080.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,018.38
|
| Rate for Payer: Mclaren Commercial |
$1,872.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,768.68
|
| Rate for Payer: Nomi Health Commercial |
$1,706.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,352.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,831.10
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
IP
|
$7,809.12
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,075.93 |
| Max. Negotiated Rate |
$7,809.12 |
| Rate for Payer: Aetna Commercial |
$7,028.21
|
| Rate for Payer: ASR ASR |
$7,574.85
|
| Rate for Payer: ASR Commercial |
$7,574.85
|
| Rate for Payer: BCBS Trust/PPO |
$6,363.65
|
| Rate for Payer: BCN Commercial |
$6,054.41
|
| Rate for Payer: Cash Price |
$6,247.30
|
| Rate for Payer: Cofinity Commercial |
$7,340.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,247.30
|
| Rate for Payer: Healthscope Commercial |
$7,809.12
|
| Rate for Payer: Healthscope Whirlpool |
$7,574.85
|
| Rate for Payer: Mclaren Commercial |
$7,028.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,637.75
|
| Rate for Payer: Nomi Health Commercial |
$6,403.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,075.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,872.03
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
OP
|
$7,809.12
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,123.65 |
| Max. Negotiated Rate |
$7,809.12 |
| Rate for Payer: Aetna Commercial |
$7,028.21
|
| Rate for Payer: Aetna Medicare |
$3,904.56
|
| Rate for Payer: ASR ASR |
$7,574.85
|
| Rate for Payer: ASR Commercial |
$7,574.85
|
| Rate for Payer: BCBS Complete |
$3,123.65
|
| Rate for Payer: BCBS Trust/PPO |
$6,394.89
|
| Rate for Payer: BCN Commercial |
$6,054.41
|
| Rate for Payer: Cash Price |
$6,247.30
|
| Rate for Payer: Cofinity Commercial |
$7,340.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,247.30
|
| Rate for Payer: Healthscope Commercial |
$7,809.12
|
| Rate for Payer: Healthscope Whirlpool |
$7,574.85
|
| Rate for Payer: Mclaren Commercial |
$7,028.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,637.75
|
| Rate for Payer: Nomi Health Commercial |
$6,403.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,075.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,842.35
|
| Rate for Payer: Priority Health Narrow Network |
$5,474.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,872.03
|
|
