|
HC REVAS ADD.VESSEL/STENT
|
Facility
|
IP
|
$18,972.73
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,952.82 |
| Max. Negotiated Rate |
$17,075.46 |
| Rate for Payer: Aetna Commercial |
$16,126.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,332.27
|
| Rate for Payer: Cash Price |
$15,178.18
|
| Rate for Payer: Cofinity Commercial |
$13,280.91
|
| Rate for Payer: Cofinity Commercial |
$16,316.55
|
| Rate for Payer: Healthscope Commercial |
$17,075.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,126.82
|
| Rate for Payer: PHP Commercial |
$16,126.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,280.91
|
| Rate for Payer: Priority Health SBD |
$11,952.82
|
|
|
HC REVAS ADD.VESSEL/STENT
|
Facility
|
OP
|
$18,972.73
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$798.69 |
| Max. Negotiated Rate |
$17,075.46 |
| Rate for Payer: Aetna Commercial |
$16,126.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,332.27
|
| Rate for Payer: BCBS Complete |
$7,589.09
|
| Rate for Payer: BCBS Trust/PPO |
$798.69
|
| Rate for Payer: Cash Price |
$15,178.18
|
| Rate for Payer: Cash Price |
$15,178.18
|
| Rate for Payer: Cofinity Commercial |
$16,316.55
|
| Rate for Payer: Cofinity Commercial |
$13,280.91
|
| Rate for Payer: Healthscope Commercial |
$17,075.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,126.82
|
| Rate for Payer: PHP Commercial |
$16,126.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,280.91
|
| Rate for Payer: Priority Health SBD |
$11,952.82
|
| Rate for Payer: UHC Core |
$7,632.00
|
|
|
HC REVAS CABG ADD.BRANCH
|
Facility
|
IP
|
$18,727.35
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
48100082
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,798.23 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,172.78
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$13,109.14
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health SBD |
$11,798.23
|
|
|
HC REVAS CABG ADD.BRANCH
|
Facility
|
OP
|
$18,727.35
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
48100082
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$710.41 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,172.78
|
| Rate for Payer: BCBS Complete |
$7,490.94
|
| Rate for Payer: BCBS Trust/PPO |
$710.41
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Cofinity Commercial |
$13,109.14
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health SBD |
$11,798.23
|
| Rate for Payer: UHC Core |
$7,632.00
|
|
|
HC REVAS CABG VES/BRANCH
|
Facility
|
IP
|
$28,586.86
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,009.72 |
| Max. Negotiated Rate |
$25,728.17 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,581.46
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$20,010.80
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health SBD |
$18,009.72
|
|
|
HC REVAS CABG VES/BRANCH
|
Facility
|
OP
|
$28,586.86
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$562.87 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,581.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$575.65
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$20,010.80
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$18,009.72
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$619.16
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$562.87
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC REVASC STENT TIB PERONL UNI INITIAL
|
Facility
|
OP
|
$11,594.76
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
36100174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.12 |
| Max. Negotiated Rate |
$51,507.72 |
| Rate for Payer: Aetna Commercial |
$9,855.55
|
| Rate for Payer: Aetna Medicare |
$16,226.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,536.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,503.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,503.28
|
| Rate for Payer: BCBS Complete |
$8,962.14
|
| Rate for Payer: BCBS MAPPO |
$15,602.62
|
| Rate for Payer: BCBS Trust/PPO |
$7,324.69
|
| Rate for Payer: BCN Medicare Advantage |
$15,602.62
|
| Rate for Payer: Cash Price |
$9,275.81
|
| Rate for Payer: Cash Price |
$9,275.81
|
| Rate for Payer: Cofinity Commercial |
$9,971.49
|
| Rate for Payer: Cofinity Commercial |
$8,116.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,602.62
|
| Rate for Payer: Healthscope Commercial |
$10,435.28
|
| Rate for Payer: Mclaren Medicaid |
$8,534.63
|
| Rate for Payer: Mclaren Medicare |
$15,602.62
|
| Rate for Payer: Meridian Medicaid |
$8,962.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,382.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,943.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,855.55
|
| Rate for Payer: PACE Medicare |
$14,822.49
|
| Rate for Payer: PACE SWMI |
$15,602.62
|
| Rate for Payer: PHP Commercial |
$9,855.55
|
| Rate for Payer: PHP Medicare Advantage |
$15,602.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,534.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,116.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,507.72
|
| Rate for Payer: Priority Health Medicare |
$15,602.62
|
| Rate for Payer: Priority Health Narrow Network |
$41,206.18
|
| Rate for Payer: Priority Health SBD |
$7,304.70
|
| Rate for Payer: Railroad Medicare Medicare |
$15,602.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$726.13
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Exchange |
$660.12
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
|
HC REVASC STENT TIB PERONL UNI INITIAL
|
Facility
|
IP
|
$11,594.76
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
36100174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,304.70 |
| Max. Negotiated Rate |
$10,435.28 |
| Rate for Payer: Aetna Commercial |
$9,855.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,536.59
|
| Rate for Payer: Cash Price |
$9,275.81
|
| Rate for Payer: Cofinity Commercial |
$8,116.33
|
| Rate for Payer: Cofinity Commercial |
$9,971.49
|
| Rate for Payer: Healthscope Commercial |
$10,435.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,855.55
|
| Rate for Payer: PHP Commercial |
$9,855.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,116.33
|
| Rate for Payer: Priority Health SBD |
$7,304.70
|
|
|
HC REVASCULARIZATION STENT FEM POP UNI
|
Facility
|
OP
|
$12,754.23
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
36100170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$494.11 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$10,841.10
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,290.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,377.04
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$10,203.38
|
| Rate for Payer: Cash Price |
$10,203.38
|
| Rate for Payer: Cofinity Commercial |
$8,927.96
|
| Rate for Payer: Cofinity Commercial |
$10,968.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$11,478.81
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,841.10
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$10,841.10
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,927.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$8,035.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.52
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$494.11
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC REVASCULARIZATION STENT FEM POP UNI
|
Facility
|
IP
|
$12,754.23
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
36100170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,035.16 |
| Max. Negotiated Rate |
$11,478.81 |
| Rate for Payer: Aetna Commercial |
$10,841.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,290.25
|
| Rate for Payer: Cash Price |
$10,203.38
|
| Rate for Payer: Cofinity Commercial |
$10,968.64
|
| Rate for Payer: Cofinity Commercial |
$8,927.96
|
| Rate for Payer: Healthscope Commercial |
$11,478.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,841.10
|
| Rate for Payer: PHP Commercial |
$10,841.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,927.96
|
| Rate for Payer: Priority Health SBD |
$8,035.16
|
|
|
HC REVAS DES/CABG ADD.
|
Facility
|
IP
|
$18,727.35
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
48100084
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,798.23 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,172.78
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$13,109.14
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health SBD |
$11,798.23
|
|
|
HC REVAS DES/CABG ADD.
|
Facility
|
OP
|
$18,727.35
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
48100084
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,172.78
|
| Rate for Payer: BCBS Complete |
$7,490.94
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$13,109.14
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health SBD |
$11,798.23
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC REVAS DES/CABG INITIAL
|
Facility
|
OP
|
$28,586.86
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
48100083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,354.45 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,581.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$8,479.25
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$20,010.80
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$18,009.72
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,444.72
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$18,707.28
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC REVAS DES/CABG INITIAL
|
Facility
|
IP
|
$28,586.86
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
48100083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,009.72 |
| Max. Negotiated Rate |
$25,728.17 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,581.46
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$20,010.80
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health SBD |
$18,009.72
|
|
|
HC REVAS MI/DES
|
Facility
|
IP
|
$29,091.52
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
48100086
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,327.66 |
| Max. Negotiated Rate |
$26,182.37 |
| Rate for Payer: Aetna Commercial |
$24,727.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,909.49
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$20,364.06
|
| Rate for Payer: Cofinity Commercial |
$25,018.71
|
| Rate for Payer: Healthscope Commercial |
$26,182.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: PHP Commercial |
$24,727.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| Rate for Payer: Priority Health SBD |
$18,327.66
|
|
|
HC REVAS MI/DES
|
Facility
|
OP
|
$29,091.52
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
48100086
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,138.00 |
| Max. Negotiated Rate |
$26,182.37 |
| Rate for Payer: Aetna Commercial |
$24,727.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,909.49
|
| Rate for Payer: BCBS Complete |
$11,636.61
|
| Rate for Payer: BCBS Trust/PPO |
$12,852.33
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$25,018.71
|
| Rate for Payer: Cofinity Commercial |
$20,364.06
|
| Rate for Payer: Healthscope Commercial |
$26,182.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: PHP Commercial |
$24,727.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| Rate for Payer: Priority Health SBD |
$18,327.66
|
| Rate for Payer: UHC Core |
$3,138.00
|
|
|
HC REVAS MI/STENT
|
Facility
|
OP
|
$29,091.52
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$631.96 |
| Max. Negotiated Rate |
$26,182.37 |
| Rate for Payer: Aetna Commercial |
$24,727.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,909.49
|
| Rate for Payer: BCBS Complete |
$11,636.61
|
| Rate for Payer: BCBS Trust/PPO |
$649.34
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$25,018.71
|
| Rate for Payer: Cofinity Commercial |
$20,364.06
|
| Rate for Payer: Healthscope Commercial |
$26,182.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: PHP Commercial |
$24,727.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| Rate for Payer: Priority Health SBD |
$18,327.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.16
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Exchange |
$631.96
|
|
|
HC REVAS MI/STENT
|
Facility
|
IP
|
$29,091.52
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,327.66 |
| Max. Negotiated Rate |
$26,182.37 |
| Rate for Payer: Aetna Commercial |
$24,727.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,909.49
|
| Rate for Payer: Cash Price |
$23,273.22
|
| Rate for Payer: Cofinity Commercial |
$20,364.06
|
| Rate for Payer: Cofinity Commercial |
$25,018.71
|
| Rate for Payer: Healthscope Commercial |
$26,182.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,727.79
|
| Rate for Payer: PHP Commercial |
$24,727.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,364.06
|
| Rate for Payer: Priority Health SBD |
$18,327.66
|
|
|
HC REVISE/REPLACE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
OP
|
$15,710.04
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
36100612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$444.01 |
| Max. Negotiated Rate |
$14,139.04 |
| Rate for Payer: Aetna Commercial |
$13,353.53
|
| Rate for Payer: Aetna Medicare |
$6,328.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,211.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,606.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,606.78
|
| Rate for Payer: BCBS Complete |
$3,495.47
|
| Rate for Payer: BCBS MAPPO |
$6,085.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,654.94
|
| Rate for Payer: BCN Medicare Advantage |
$6,085.42
|
| Rate for Payer: Cash Price |
$12,568.03
|
| Rate for Payer: Cash Price |
$12,568.03
|
| Rate for Payer: Cofinity Commercial |
$10,997.03
|
| Rate for Payer: Cofinity Commercial |
$13,510.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,085.42
|
| Rate for Payer: Healthscope Commercial |
$14,139.04
|
| Rate for Payer: Mclaren Medicaid |
$3,328.72
|
| Rate for Payer: Mclaren Medicare |
$6,085.42
|
| Rate for Payer: Meridian Medicaid |
$3,495.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,389.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,998.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,353.53
|
| Rate for Payer: PACE Medicare |
$5,781.15
|
| Rate for Payer: PACE SWMI |
$6,085.42
|
| Rate for Payer: PHP Commercial |
$13,353.53
|
| Rate for Payer: PHP Medicare Advantage |
$6,085.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,328.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,997.03
|
| Rate for Payer: Priority Health Medicare |
$6,085.42
|
| Rate for Payer: Priority Health SBD |
$9,897.33
|
| Rate for Payer: Railroad Medicare Medicare |
$6,085.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.41
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,085.42
|
| Rate for Payer: UHC Exchange |
$444.01
|
| Rate for Payer: UHC Medicare Advantage |
$6,267.98
|
| Rate for Payer: VA VA |
$6,085.42
|
|
|
HC REVISE/REPLACE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
IP
|
$15,710.04
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
36100612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,897.33 |
| Max. Negotiated Rate |
$14,139.04 |
| Rate for Payer: Aetna Commercial |
$13,353.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,211.53
|
| Rate for Payer: Cash Price |
$12,568.03
|
| Rate for Payer: Cofinity Commercial |
$13,510.63
|
| Rate for Payer: Cofinity Commercial |
$10,997.03
|
| Rate for Payer: Healthscope Commercial |
$14,139.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,353.53
|
| Rate for Payer: PHP Commercial |
$13,353.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,997.03
|
| Rate for Payer: Priority Health SBD |
$9,897.33
|
|
|
HC RF ABLATION KIDNEY TUMOR
|
Facility
|
OP
|
$7,263.14
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
36100247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.75 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Commercial |
$6,173.67
|
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,721.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,286.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Cash Price |
$5,810.51
|
| Rate for Payer: Cash Price |
$5,810.51
|
| Rate for Payer: Cofinity Commercial |
$6,246.30
|
| Rate for Payer: Cofinity Commercial |
$5,084.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Healthscope Commercial |
$6,536.83
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,173.67
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Commercial |
$6,173.67
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,084.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Priority Health SBD |
$4,575.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.62
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$328.75
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
HC RF ABLATION KIDNEY TUMOR
|
Facility
|
IP
|
$7,263.14
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
36100247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,575.78 |
| Max. Negotiated Rate |
$6,536.83 |
| Rate for Payer: Aetna Commercial |
$6,173.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,721.04
|
| Rate for Payer: Cash Price |
$5,810.51
|
| Rate for Payer: Cofinity Commercial |
$5,084.20
|
| Rate for Payer: Cofinity Commercial |
$6,246.30
|
| Rate for Payer: Healthscope Commercial |
$6,536.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,173.67
|
| Rate for Payer: PHP Commercial |
$6,173.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,084.20
|
| Rate for Payer: Priority Health SBD |
$4,575.78
|
|
|
HC RF ABLATION LIVER TUMOR
|
Facility
|
OP
|
$5,770.46
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
36100199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$704.33 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Commercial |
$4,904.89
|
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,750.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,360.95
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Cash Price |
$4,616.37
|
| Rate for Payer: Cash Price |
$4,616.37
|
| Rate for Payer: Cofinity Commercial |
$4,962.60
|
| Rate for Payer: Cofinity Commercial |
$4,039.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Healthscope Commercial |
$5,193.41
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,904.89
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Commercial |
$4,904.89
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,039.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Priority Health SBD |
$3,635.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$774.76
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$704.33
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
HC RF ABLATION LIVER TUMOR
|
Facility
|
IP
|
$5,770.46
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
36100199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,635.39 |
| Max. Negotiated Rate |
$5,193.41 |
| Rate for Payer: Aetna Commercial |
$4,904.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,750.80
|
| Rate for Payer: Cash Price |
$4,616.37
|
| Rate for Payer: Cofinity Commercial |
$4,039.32
|
| Rate for Payer: Cofinity Commercial |
$4,962.60
|
| Rate for Payer: Healthscope Commercial |
$5,193.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,904.89
|
| Rate for Payer: PHP Commercial |
$4,904.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,039.32
|
| Rate for Payer: Priority Health SBD |
$3,635.39
|
|
|
HC RFABLATION NRV INNERVATING SI JT W IMAG
|
Facility
|
IP
|
$2,630.61
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
36100594
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,657.28 |
| Max. Negotiated Rate |
$2,367.55 |
| Rate for Payer: Aetna Commercial |
$2,236.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,709.90
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cofinity Commercial |
$1,841.43
|
| Rate for Payer: Cofinity Commercial |
$2,262.32
|
| Rate for Payer: Healthscope Commercial |
$2,367.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,236.02
|
| Rate for Payer: PHP Commercial |
$2,236.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.43
|
| Rate for Payer: Priority Health SBD |
$1,657.28
|
|
