|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
OP
|
$6,319.92
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,338.37 |
| Max. Negotiated Rate |
$6,319.92 |
| Rate for Payer: Aetna Commercial |
$5,687.93
|
| Rate for Payer: Aetna Medicare |
$2,338.37
|
| Rate for Payer: ASR ASR |
$6,130.32
|
| Rate for Payer: BCBS Complete |
$2,527.97
|
| Rate for Payer: BCBS Trust/PPO |
$5,210.77
|
| Rate for Payer: BCN Commercial |
$5,210.77
|
| Rate for Payer: Cash Price |
$5,055.94
|
| Rate for Payer: Cofinity Commercial |
$5,940.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,055.94
|
| Rate for Payer: Healthscope Commercial |
$6,130.32
|
| Rate for Payer: Healthscope Whirlpool |
$6,319.92
|
| Rate for Payer: Mclaren Commercial |
$5,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,055.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,371.93
|
| Rate for Payer: Nomi Health Commercial |
$5,182.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,739.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,537.51
|
| Rate for Payer: Priority Health Narrow Network |
$4,430.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,561.53
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
IP
|
$6,319.92
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,739.94 |
| Max. Negotiated Rate |
$6,319.92 |
| Rate for Payer: Aetna Commercial |
$5,687.93
|
| Rate for Payer: ASR ASR |
$6,130.32
|
| Rate for Payer: BCBS Trust/PPO |
$5,189.92
|
| Rate for Payer: BCN Commercial |
$5,189.92
|
| Rate for Payer: Cash Price |
$5,055.94
|
| Rate for Payer: Cofinity Commercial |
$5,940.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,055.94
|
| Rate for Payer: Healthscope Commercial |
$6,130.32
|
| Rate for Payer: Healthscope Whirlpool |
$6,319.92
|
| Rate for Payer: Mclaren Commercial |
$5,687.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,371.93
|
| Rate for Payer: Nomi Health Commercial |
$5,182.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,739.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,561.53
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
IP
|
$8,315.04
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,236.28 |
| Max. Negotiated Rate |
$8,315.04 |
| Rate for Payer: Aetna Commercial |
$7,483.54
|
| Rate for Payer: ASR ASR |
$8,065.59
|
| Rate for Payer: BCBS Trust/PPO |
$6,828.31
|
| Rate for Payer: BCN Commercial |
$6,828.31
|
| Rate for Payer: Cash Price |
$6,652.03
|
| Rate for Payer: Cofinity Commercial |
$7,816.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,652.03
|
| Rate for Payer: Healthscope Commercial |
$8,065.59
|
| Rate for Payer: Healthscope Whirlpool |
$8,315.04
|
| Rate for Payer: Mclaren Commercial |
$7,483.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,067.78
|
| Rate for Payer: Nomi Health Commercial |
$6,818.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,236.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,317.24
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
OP
|
$8,315.04
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,076.56 |
| Max. Negotiated Rate |
$8,315.04 |
| Rate for Payer: Aetna Commercial |
$7,483.54
|
| Rate for Payer: Aetna Medicare |
$3,076.56
|
| Rate for Payer: ASR ASR |
$8,065.59
|
| Rate for Payer: BCBS Complete |
$3,326.02
|
| Rate for Payer: BCBS Trust/PPO |
$6,855.75
|
| Rate for Payer: BCN Commercial |
$6,855.75
|
| Rate for Payer: Cash Price |
$6,652.03
|
| Rate for Payer: Cofinity Commercial |
$7,816.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,652.03
|
| Rate for Payer: Healthscope Commercial |
$8,065.59
|
| Rate for Payer: Healthscope Whirlpool |
$8,315.04
|
| Rate for Payer: Mclaren Commercial |
$7,483.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,652.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,067.78
|
| Rate for Payer: Nomi Health Commercial |
$6,818.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,236.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,285.64
|
| Rate for Payer: Priority Health Narrow Network |
$5,828.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,317.24
|
|
|
HC PACEMAKER TESTING CABLE
|
Facility
|
IP
|
$116.98
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.73 |
| Max. Negotiated Rate |
$116.98 |
| Rate for Payer: Aetna Commercial |
$105.28
|
| Rate for Payer: ASR ASR |
$113.47
|
| Rate for Payer: BCBS Trust/PPO |
$96.06
|
| Rate for Payer: BCN Commercial |
$96.06
|
| Rate for Payer: Cash Price |
$93.58
|
| Rate for Payer: Cofinity Commercial |
$109.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.58
|
| Rate for Payer: Healthscope Commercial |
$113.47
|
| Rate for Payer: Healthscope Whirlpool |
$116.98
|
| Rate for Payer: Mclaren Commercial |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.43
|
| Rate for Payer: Nomi Health Commercial |
$95.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.94
|
|
|
HC PACEMAKER TESTING CABLE
|
Facility
|
OP
|
$116.98
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$116.98 |
| Rate for Payer: Aetna Commercial |
$105.28
|
| Rate for Payer: Aetna Medicare |
$43.28
|
| Rate for Payer: ASR ASR |
$113.47
|
| Rate for Payer: BCBS Complete |
$46.79
|
| Rate for Payer: BCBS Trust/PPO |
$96.45
|
| Rate for Payer: BCN Commercial |
$96.45
|
| Rate for Payer: Cash Price |
$93.58
|
| Rate for Payer: Cofinity Commercial |
$109.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.58
|
| Rate for Payer: Healthscope Commercial |
$113.47
|
| Rate for Payer: Healthscope Whirlpool |
$116.98
|
| Rate for Payer: Mclaren Commercial |
$105.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.43
|
| Rate for Payer: Nomi Health Commercial |
$95.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$102.50
|
| Rate for Payer: Priority Health Narrow Network |
$82.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.94
|
|
|
HC PACER POCKET REVISION
|
Facility
|
OP
|
$2,893.52
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$3,186.58 |
| Rate for Payer: Aetna Commercial |
$2,604.17
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$2,806.71
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,385.71
|
| Rate for Payer: BCN Commercial |
$2,385.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,314.82
|
| Rate for Payer: Cash Price |
$2,314.82
|
| Rate for Payer: Cofinity Commercial |
$2,719.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,314.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$2,806.71
|
| Rate for Payer: Healthscope Whirlpool |
$2,893.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$2,604.17
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,459.49
|
| Rate for Payer: Nomi Health Commercial |
$2,372.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,170.14
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,535.30
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,028.36
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,546.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC PACER POCKET REVISION
|
Facility
|
IP
|
$2,893.52
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,170.14 |
| Max. Negotiated Rate |
$2,893.52 |
| Rate for Payer: Aetna Commercial |
$2,604.17
|
| Rate for Payer: ASR ASR |
$2,806.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,376.16
|
| Rate for Payer: BCN Commercial |
$2,376.16
|
| Rate for Payer: Cash Price |
$2,314.82
|
| Rate for Payer: Cofinity Commercial |
$2,719.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,314.82
|
| Rate for Payer: Healthscope Commercial |
$2,806.71
|
| Rate for Payer: Healthscope Whirlpool |
$2,893.52
|
| Rate for Payer: Mclaren Commercial |
$2,604.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,459.49
|
| Rate for Payer: Nomi Health Commercial |
$2,372.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,170.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,546.30
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
IP
|
$780.30
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$585.23 |
| Max. Negotiated Rate |
$780.30 |
| Rate for Payer: Aetna Commercial |
$702.27
|
| Rate for Payer: ASR ASR |
$756.89
|
| Rate for Payer: BCBS Trust/PPO |
$640.78
|
| Rate for Payer: BCN Commercial |
$640.78
|
| Rate for Payer: Cash Price |
$624.24
|
| Rate for Payer: Cofinity Commercial |
$733.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.24
|
| Rate for Payer: Healthscope Commercial |
$756.89
|
| Rate for Payer: Healthscope Whirlpool |
$780.30
|
| Rate for Payer: Mclaren Commercial |
$702.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.25
|
| Rate for Payer: Nomi Health Commercial |
$639.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$686.66
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
OP
|
$780.30
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$288.71 |
| Max. Negotiated Rate |
$780.30 |
| Rate for Payer: Aetna Commercial |
$702.27
|
| Rate for Payer: Aetna Medicare |
$288.71
|
| Rate for Payer: ASR ASR |
$756.89
|
| Rate for Payer: BCBS Complete |
$312.12
|
| Rate for Payer: BCBS Trust/PPO |
$643.36
|
| Rate for Payer: BCN Commercial |
$643.36
|
| Rate for Payer: Cash Price |
$624.24
|
| Rate for Payer: Cofinity Commercial |
$733.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.24
|
| Rate for Payer: Healthscope Commercial |
$756.89
|
| Rate for Payer: Healthscope Whirlpool |
$780.30
|
| Rate for Payer: Mclaren Commercial |
$702.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$624.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.25
|
| Rate for Payer: Nomi Health Commercial |
$639.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$683.70
|
| Rate for Payer: Priority Health Narrow Network |
$546.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$686.66
|
|
|
HC PACKED CELLS DIRECT
|
Facility
|
IP
|
$841.79
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$631.34 |
| Max. Negotiated Rate |
$841.79 |
| Rate for Payer: Aetna Commercial |
$757.61
|
| Rate for Payer: ASR ASR |
$816.54
|
| Rate for Payer: BCBS Trust/PPO |
$691.28
|
| Rate for Payer: BCN Commercial |
$691.28
|
| Rate for Payer: Cash Price |
$673.43
|
| Rate for Payer: Cofinity Commercial |
$791.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.43
|
| Rate for Payer: Healthscope Commercial |
$816.54
|
| Rate for Payer: Healthscope Whirlpool |
$841.79
|
| Rate for Payer: Mclaren Commercial |
$757.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.52
|
| Rate for Payer: Nomi Health Commercial |
$690.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.78
|
|
|
HC PACKED CELLS DIRECT
|
Facility
|
OP
|
$841.79
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$841.79 |
| Rate for Payer: Aetna Commercial |
$757.61
|
| Rate for Payer: Aetna Medicare |
$180.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.43
|
| Rate for Payer: ASR ASR |
$816.54
|
| Rate for Payer: BCBS Complete |
$99.04
|
| Rate for Payer: BCBS MAPPO |
$180.34
|
| Rate for Payer: BCBS Trust/PPO |
$694.06
|
| Rate for Payer: BCN Commercial |
$694.06
|
| Rate for Payer: BCN Medicare Advantage |
$180.34
|
| Rate for Payer: Cash Price |
$673.43
|
| Rate for Payer: Cash Price |
$673.43
|
| Rate for Payer: Cofinity Commercial |
$791.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.34
|
| Rate for Payer: Healthscope Commercial |
$816.54
|
| Rate for Payer: Healthscope Whirlpool |
$841.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$180.34
|
| Rate for Payer: Mclaren Commercial |
$757.61
|
| Rate for Payer: Mclaren Medicaid |
$180.34
|
| Rate for Payer: Mclaren Medicare |
$180.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.36
|
| Rate for Payer: Meridian Medicaid |
$99.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$198.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.52
|
| Rate for Payer: Nomi Health Commercial |
$690.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.34
|
| Rate for Payer: PACE Medicare |
$171.32
|
| Rate for Payer: PACE SWMI |
$180.34
|
| Rate for Payer: PHP Commercial |
$198.37
|
| Rate for Payer: PHP Medicaid |
$96.66
|
| Rate for Payer: PHP Medicare Advantage |
$180.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$347.44
|
| Rate for Payer: Priority Health Medicare |
$180.34
|
| Rate for Payer: Priority Health Narrow Network |
$277.96
|
| Rate for Payer: Railroad Medicare Medicare |
$180.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$180.34
|
| Rate for Payer: UHC Exchange |
$279.53
|
| Rate for Payer: UHC Medicaid |
$94.32
|
| Rate for Payer: UHCCP DNSP |
$180.34
|
| Rate for Payer: UHCCP Medicaid |
$94.32
|
| Rate for Payer: VA VA |
$180.34
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
IP
|
$1,282.23
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$961.67 |
| Max. Negotiated Rate |
$1,282.23 |
| Rate for Payer: Aetna Commercial |
$1,154.01
|
| Rate for Payer: ASR ASR |
$1,243.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,052.97
|
| Rate for Payer: BCN Commercial |
$1,052.97
|
| Rate for Payer: Cash Price |
$1,025.78
|
| Rate for Payer: Cofinity Commercial |
$1,205.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,025.78
|
| Rate for Payer: Healthscope Commercial |
$1,243.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,282.23
|
| Rate for Payer: Mclaren Commercial |
$1,154.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,089.90
|
| Rate for Payer: Nomi Health Commercial |
$1,051.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$961.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,128.36
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
OP
|
$1,282.23
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$135.38 |
| Max. Negotiated Rate |
$1,282.23 |
| Rate for Payer: Aetna Commercial |
$1,154.01
|
| Rate for Payer: Aetna Medicare |
$258.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.56
|
| Rate for Payer: ASR ASR |
$1,243.76
|
| Rate for Payer: BCBS Complete |
$142.16
|
| Rate for Payer: BCBS MAPPO |
$258.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,057.20
|
| Rate for Payer: BCN Commercial |
$1,057.20
|
| Rate for Payer: BCN Medicare Advantage |
$258.85
|
| Rate for Payer: Cash Price |
$1,025.78
|
| Rate for Payer: Cash Price |
$1,025.78
|
| Rate for Payer: Cofinity Commercial |
$1,205.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,025.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.85
|
| Rate for Payer: Healthscope Commercial |
$1,243.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,282.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$258.85
|
| Rate for Payer: Mclaren Commercial |
$1,154.01
|
| Rate for Payer: Mclaren Medicaid |
$258.85
|
| Rate for Payer: Mclaren Medicare |
$258.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.79
|
| Rate for Payer: Meridian Medicaid |
$142.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$284.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,089.90
|
| Rate for Payer: Nomi Health Commercial |
$1,051.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$961.67
|
| Rate for Payer: PACE Medicare |
$245.91
|
| Rate for Payer: PACE SWMI |
$258.85
|
| Rate for Payer: PHP Commercial |
$284.74
|
| Rate for Payer: PHP Medicaid |
$138.74
|
| Rate for Payer: PHP Medicare Advantage |
$258.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$600.44
|
| Rate for Payer: Priority Health Medicare |
$258.85
|
| Rate for Payer: Priority Health Narrow Network |
$480.35
|
| Rate for Payer: Railroad Medicare Medicare |
$258.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,128.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$258.85
|
| Rate for Payer: UHC Exchange |
$401.22
|
| Rate for Payer: UHC Medicaid |
$135.38
|
| Rate for Payer: UHCCP DNSP |
$258.85
|
| Rate for Payer: UHCCP Medicaid |
$135.38
|
| Rate for Payer: VA VA |
$258.85
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
OP
|
$99.88
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$99.88 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$36.96
|
| Rate for Payer: ASR ASR |
$96.88
|
| Rate for Payer: BCBS Complete |
$39.95
|
| Rate for Payer: BCBS Trust/PPO |
$82.35
|
| Rate for Payer: BCN Commercial |
$82.35
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Commercial |
$93.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Healthscope Commercial |
$96.88
|
| Rate for Payer: Healthscope Whirlpool |
$99.88
|
| Rate for Payer: Mclaren Commercial |
$89.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Nomi Health Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$87.51
|
| Rate for Payer: Priority Health Narrow Network |
$70.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.89
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
IP
|
$99.88
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$99.88 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: ASR ASR |
$96.88
|
| Rate for Payer: BCBS Trust/PPO |
$82.02
|
| Rate for Payer: BCN Commercial |
$82.02
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Commercial |
$93.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Healthscope Commercial |
$96.88
|
| Rate for Payer: Healthscope Whirlpool |
$99.88
|
| Rate for Payer: Mclaren Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Nomi Health Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.89
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
OP
|
$702.27
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$259.84 |
| Max. Negotiated Rate |
$702.27 |
| Rate for Payer: Aetna Commercial |
$632.04
|
| Rate for Payer: Aetna Medicare |
$259.84
|
| Rate for Payer: ASR ASR |
$681.20
|
| Rate for Payer: BCBS Complete |
$280.91
|
| Rate for Payer: BCBS Trust/PPO |
$579.02
|
| Rate for Payer: BCN Commercial |
$579.02
|
| Rate for Payer: Cash Price |
$561.82
|
| Rate for Payer: Cofinity Commercial |
$660.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.82
|
| Rate for Payer: Healthscope Commercial |
$681.20
|
| Rate for Payer: Healthscope Whirlpool |
$702.27
|
| Rate for Payer: Mclaren Commercial |
$632.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.93
|
| Rate for Payer: Nomi Health Commercial |
$575.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$615.33
|
| Rate for Payer: Priority Health Narrow Network |
$492.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$618.00
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
IP
|
$702.27
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$526.70 |
| Max. Negotiated Rate |
$702.27 |
| Rate for Payer: Aetna Commercial |
$632.04
|
| Rate for Payer: ASR ASR |
$681.20
|
| Rate for Payer: BCBS Trust/PPO |
$576.70
|
| Rate for Payer: BCN Commercial |
$576.70
|
| Rate for Payer: Cash Price |
$561.82
|
| Rate for Payer: Cofinity Commercial |
$660.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.82
|
| Rate for Payer: Healthscope Commercial |
$681.20
|
| Rate for Payer: Healthscope Whirlpool |
$702.27
|
| Rate for Payer: Mclaren Commercial |
$632.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.93
|
| Rate for Payer: Nomi Health Commercial |
$575.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$618.00
|
|
|
HC PACK TABLE LINE
|
Facility
|
IP
|
$209.12
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.84 |
| Max. Negotiated Rate |
$209.12 |
| Rate for Payer: Aetna Commercial |
$188.21
|
| Rate for Payer: ASR ASR |
$202.85
|
| Rate for Payer: BCBS Trust/PPO |
$171.73
|
| Rate for Payer: BCN Commercial |
$171.73
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: Cofinity Commercial |
$196.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.30
|
| Rate for Payer: Healthscope Commercial |
$202.85
|
| Rate for Payer: Healthscope Whirlpool |
$209.12
|
| Rate for Payer: Mclaren Commercial |
$188.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.75
|
| Rate for Payer: Nomi Health Commercial |
$171.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.03
|
|
|
HC PACK TABLE LINE
|
Facility
|
OP
|
$209.12
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.37 |
| Max. Negotiated Rate |
$209.12 |
| Rate for Payer: Aetna Commercial |
$188.21
|
| Rate for Payer: Aetna Medicare |
$77.37
|
| Rate for Payer: ASR ASR |
$202.85
|
| Rate for Payer: BCBS Complete |
$83.65
|
| Rate for Payer: BCBS Trust/PPO |
$172.42
|
| Rate for Payer: BCN Commercial |
$172.42
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: Cofinity Commercial |
$196.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.30
|
| Rate for Payer: Healthscope Commercial |
$202.85
|
| Rate for Payer: Healthscope Whirlpool |
$209.12
|
| Rate for Payer: Mclaren Commercial |
$188.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.75
|
| Rate for Payer: Nomi Health Commercial |
$171.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$183.23
|
| Rate for Payer: Priority Health Narrow Network |
$146.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.03
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
IP
|
$858.33
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$643.75 |
| Max. Negotiated Rate |
$858.33 |
| Rate for Payer: Aetna Commercial |
$772.50
|
| Rate for Payer: ASR ASR |
$832.58
|
| Rate for Payer: BCBS Trust/PPO |
$704.86
|
| Rate for Payer: BCN Commercial |
$704.86
|
| Rate for Payer: Cash Price |
$686.66
|
| Rate for Payer: Cofinity Commercial |
$806.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.66
|
| Rate for Payer: Healthscope Commercial |
$832.58
|
| Rate for Payer: Healthscope Whirlpool |
$858.33
|
| Rate for Payer: Mclaren Commercial |
$772.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$729.58
|
| Rate for Payer: Nomi Health Commercial |
$703.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$643.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.33
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
OP
|
$858.33
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$317.58 |
| Max. Negotiated Rate |
$858.33 |
| Rate for Payer: Aetna Commercial |
$772.50
|
| Rate for Payer: Aetna Medicare |
$317.58
|
| Rate for Payer: ASR ASR |
$832.58
|
| Rate for Payer: BCBS Complete |
$343.33
|
| Rate for Payer: BCBS Trust/PPO |
$707.69
|
| Rate for Payer: BCN Commercial |
$707.69
|
| Rate for Payer: Cash Price |
$686.66
|
| Rate for Payer: Cofinity Commercial |
$806.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.66
|
| Rate for Payer: Healthscope Commercial |
$832.58
|
| Rate for Payer: Healthscope Whirlpool |
$858.33
|
| Rate for Payer: Mclaren Commercial |
$772.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$729.58
|
| Rate for Payer: Nomi Health Commercial |
$703.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$643.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$752.07
|
| Rate for Payer: Priority Health Narrow Network |
$601.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.33
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
OP
|
$167.67
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$167.67 |
| Rate for Payer: Aetna Commercial |
$150.90
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$162.64
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$138.24
|
| Rate for Payer: BCN Commercial |
$138.24
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$134.14
|
| Rate for Payer: Cash Price |
$134.14
|
| Rate for Payer: Cofinity Commercial |
$157.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$162.64
|
| Rate for Payer: Healthscope Whirlpool |
$167.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$150.90
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.52
|
| Rate for Payer: Nomi Health Commercial |
$137.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.75
|
| 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 |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$146.91
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$117.54
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
IP
|
$167.67
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.75 |
| Max. Negotiated Rate |
$167.67 |
| Rate for Payer: Aetna Commercial |
$150.90
|
| Rate for Payer: ASR ASR |
$162.64
|
| Rate for Payer: BCBS Trust/PPO |
$137.69
|
| Rate for Payer: BCN Commercial |
$137.69
|
| Rate for Payer: Cash Price |
$134.14
|
| Rate for Payer: Cofinity Commercial |
$157.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.14
|
| Rate for Payer: Healthscope Commercial |
$162.64
|
| Rate for Payer: Healthscope Whirlpool |
$167.67
|
| Rate for Payer: Mclaren Commercial |
$150.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.52
|
| Rate for Payer: Nomi Health Commercial |
$137.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.55
|
|
|
HC PAIN PUMP ADJUSTMENT
|
Facility
|
OP
|
$151.79
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$151.79 |
| Rate for Payer: Aetna Commercial |
$136.61
|
| Rate for Payer: Aetna Medicare |
$56.16
|
| Rate for Payer: ASR ASR |
$147.24
|
| Rate for Payer: BCBS Complete |
$60.72
|
| Rate for Payer: BCBS Trust/PPO |
$125.15
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$125.15
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$142.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$147.24
|
| Rate for Payer: Healthscope Whirlpool |
$151.79
|
| Rate for Payer: Mclaren Commercial |
$136.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.02
|
| Rate for Payer: Nomi Health Commercial |
$124.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.95
|
| Rate for Payer: Priority Health Narrow Network |
$105.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.58
|
|
