|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON
|
Facility
|
IP
|
$29,485.58
|
|
|
Service Code
|
CPT 0913T
|
| Hospital Charge Code |
48100152
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,575.92 |
| Max. Negotiated Rate |
$26,537.02 |
| Rate for Payer: Aetna Commercial |
$25,062.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,165.63
|
| Rate for Payer: Cash Price |
$23,588.46
|
| Rate for Payer: Cofinity Advantage |
$20,639.91
|
| Rate for Payer: Cofinity Commercial |
$25,357.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,588.46
|
| Rate for Payer: Healthscope Commercial |
$26,537.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,062.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,114.19
|
| Rate for Payer: PHP Commercial |
$25,062.74
|
| Rate for Payer: Priority Health SBD |
$18,575.92
|
|
|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON SEP LESION
|
Facility
|
IP
|
$14,742.79
|
|
|
Service Code
|
CPT 0914T
|
| Hospital Charge Code |
48100153
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,287.96 |
| Max. Negotiated Rate |
$13,268.51 |
| Rate for Payer: Aetna Commercial |
$12,531.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,582.81
|
| Rate for Payer: Cash Price |
$11,794.23
|
| Rate for Payer: Cofinity Advantage |
$10,319.95
|
| Rate for Payer: Cofinity Commercial |
$12,678.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,794.23
|
| Rate for Payer: Healthscope Commercial |
$13,268.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,531.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,057.09
|
| Rate for Payer: PHP Commercial |
$12,531.37
|
| Rate for Payer: Priority Health SBD |
$9,287.96
|
|
|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON SEP LESION
|
Facility
|
OP
|
$14,742.79
|
|
|
Service Code
|
CPT 0914T
|
| Hospital Charge Code |
48100153
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,897.12 |
| Max. Negotiated Rate |
$13,268.51 |
| Rate for Payer: Aetna Commercial |
$12,531.37
|
| Rate for Payer: Aetna Medicare |
$7,371.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,582.81
|
| Rate for Payer: BCBS Complete |
$5,897.12
|
| Rate for Payer: Cash Price |
$11,794.23
|
| Rate for Payer: Cofinity Advantage |
$10,319.95
|
| Rate for Payer: Cofinity Commercial |
$12,678.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,794.23
|
| Rate for Payer: Healthscope Commercial |
$13,268.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,794.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,531.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,057.09
|
| Rate for Payer: PHP Commercial |
$12,531.37
|
| Rate for Payer: Priority Health SBD |
$9,287.96
|
|
|
HC PERQ TRANSL ANGIOPLASTY W IVUS OR OCT
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C7569
|
| Hospital Charge Code |
48100149
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,584.00 |
| Max. Negotiated Rate |
$15,120.00 |
| Rate for Payer: Aetna Commercial |
$14,280.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,920.00
|
| Rate for Payer: Cash Price |
$13,440.00
|
| Rate for Payer: Cofinity Advantage |
$11,760.00
|
| Rate for Payer: Cofinity Commercial |
$14,448.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,440.00
|
| Rate for Payer: Healthscope Commercial |
$15,120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,280.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,600.00
|
| Rate for Payer: PHP Commercial |
$14,280.00
|
| Rate for Payer: Priority Health SBD |
$10,584.00
|
|
|
HC PERQ TRANSL ANGIOPLASTY W IVUS OR OCT
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C7569
|
| Hospital Charge Code |
48100149
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,720.00 |
| Max. Negotiated Rate |
$15,120.00 |
| Rate for Payer: Aetna Commercial |
$14,280.00
|
| Rate for Payer: Aetna Medicare |
$8,400.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,920.00
|
| Rate for Payer: BCBS Complete |
$6,720.00
|
| Rate for Payer: Cash Price |
$13,440.00
|
| Rate for Payer: Cofinity Advantage |
$11,760.00
|
| Rate for Payer: Cofinity Commercial |
$14,448.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,440.00
|
| Rate for Payer: Healthscope Commercial |
$15,120.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,440.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,280.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,600.00
|
| Rate for Payer: PHP Commercial |
$14,280.00
|
| Rate for Payer: Priority Health SBD |
$10,584.00
|
|
|
HC PERQ TRANSL ANGIOPLASTY W LITHOTRIPSY
|
Facility
|
IP
|
$28,750.00
|
|
|
Service Code
|
HCPCS C7571
|
| Hospital Charge Code |
48100150
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,112.50 |
| Max. Negotiated Rate |
$25,875.00 |
| Rate for Payer: Aetna Commercial |
$24,437.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,687.50
|
| Rate for Payer: Cash Price |
$23,000.00
|
| Rate for Payer: Cofinity Advantage |
$20,125.00
|
| Rate for Payer: Cofinity Commercial |
$24,725.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,000.00
|
| Rate for Payer: Healthscope Commercial |
$25,875.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,437.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,562.50
|
| Rate for Payer: PHP Commercial |
$24,437.50
|
| Rate for Payer: Priority Health SBD |
$18,112.50
|
|
|
HC PERQ TRANSL ANGIOPLASTY W LITHOTRIPSY
|
Facility
|
OP
|
$28,750.00
|
|
|
Service Code
|
HCPCS C7571
|
| Hospital Charge Code |
48100150
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,500.00 |
| Max. Negotiated Rate |
$25,875.00 |
| Rate for Payer: Aetna Commercial |
$24,437.50
|
| Rate for Payer: Aetna Medicare |
$14,375.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,687.50
|
| Rate for Payer: BCBS Complete |
$11,500.00
|
| Rate for Payer: Cash Price |
$23,000.00
|
| Rate for Payer: Cofinity Advantage |
$20,125.00
|
| Rate for Payer: Cofinity Commercial |
$24,725.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,000.00
|
| Rate for Payer: Healthscope Commercial |
$25,875.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,437.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,562.50
|
| Rate for Payer: PHP Commercial |
$24,437.50
|
| Rate for Payer: Priority Health SBD |
$18,112.50
|
|
|
HC PERQ TRANSL CORONARY ATHERECT W INTRACOR STENT
|
Facility
|
IP
|
$49,300.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100145
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$31,059.00 |
| Max. Negotiated Rate |
$44,370.00 |
| Rate for Payer: Aetna Commercial |
$41,905.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,045.00
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Advantage |
$34,510.00
|
| Rate for Payer: Cofinity Commercial |
$42,398.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Healthscope Commercial |
$44,370.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: PHP Commercial |
$41,905.00
|
| Rate for Payer: Priority Health SBD |
$31,059.00
|
|
|
HC PERQ TRANSL CORONARY ATHERECT W INTRACOR STENT
|
Facility
|
OP
|
$49,300.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100145
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$187.07 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$41,905.00
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,045.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$187.07
|
| Rate for Payer: BCN Commercial |
$187.07
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Advantage |
$34,510.00
|
| Rate for Payer: Cofinity Commercial |
$42,398.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$44,370.00
|
| Rate for Payer: Mclaren Medicaid |
$9,552.97
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$19,179.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$41,905.00
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,069.70
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health SBD |
$31,059.00
|
| Rate for Payer: Priority Health Tiered Network |
$47,255.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC PERQ TRANSL INTRACOR STENT ARTERY/BRANCHES 1 LESION
|
Facility
|
OP
|
$25,200.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100143
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$21,420.00
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,380.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$7,409.86
|
| Rate for Payer: BCN Commercial |
$7,409.86
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$20,160.00
|
| Rate for Payer: Cash Price |
$20,160.00
|
| Rate for Payer: Cash Price |
$20,160.00
|
| Rate for Payer: Cofinity Advantage |
$17,640.00
|
| Rate for Payer: Cofinity Commercial |
$21,672.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$22,680.00
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,420.00
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,900.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$21,420.00
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$15,876.00
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRANSL INTRACOR STENT ARTERY/BRANCHES 1 LESION
|
Facility
|
IP
|
$25,200.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100143
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$15,876.00 |
| Max. Negotiated Rate |
$22,680.00 |
| Rate for Payer: Aetna Commercial |
$21,420.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,380.00
|
| Rate for Payer: Cash Price |
$20,160.00
|
| Rate for Payer: Cofinity Advantage |
$17,640.00
|
| Rate for Payer: Cofinity Commercial |
$21,672.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,160.00
|
| Rate for Payer: Healthscope Commercial |
$22,680.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,420.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,900.00
|
| Rate for Payer: PHP Commercial |
$21,420.00
|
| Rate for Payer: Priority Health SBD |
$15,876.00
|
|
|
HC PERQ TRANSL INTRACOR STENTS ARTERY/BRANCHES 2+ LESIONS
|
Facility
|
OP
|
$42,600.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
48100144
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,552.97 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$36,210.00
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,690.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$34,080.00
|
| Rate for Payer: Cash Price |
$34,080.00
|
| Rate for Payer: Cofinity Advantage |
$29,820.00
|
| Rate for Payer: Cofinity Commercial |
$36,636.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,080.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$38,340.00
|
| Rate for Payer: Mclaren Medicaid |
$9,552.97
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$19,179.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,210.00
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,950.00
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$36,210.00
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,069.70
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health SBD |
$26,838.00
|
| Rate for Payer: Priority Health Tiered Network |
$47,255.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC PERQ TRANSL INTRACOR STENTS ARTERY/BRANCHES 2+ LESIONS
|
Facility
|
IP
|
$42,600.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
48100144
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$26,838.00 |
| Max. Negotiated Rate |
$38,340.00 |
| Rate for Payer: Aetna Commercial |
$36,210.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,690.00
|
| Rate for Payer: Cash Price |
$34,080.00
|
| Rate for Payer: Cofinity Advantage |
$29,820.00
|
| Rate for Payer: Cofinity Commercial |
$36,636.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,080.00
|
| Rate for Payer: Healthscope Commercial |
$38,340.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,210.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,950.00
|
| Rate for Payer: PHP Commercial |
$36,210.00
|
| Rate for Payer: Priority Health SBD |
$26,838.00
|
|
|
HC PERQ TRANSL REVASC AMI/PCI
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100147
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$31,500.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Priority Health SBD |
$31,500.00
|
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,500.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Advantage |
$35,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
|
|
HC PERQ TRANSL REVASC AMI/PCI
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100147
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$187.51 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna Medicare |
$25,000.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,500.00
|
| Rate for Payer: BCBS Complete |
$20,000.00
|
| Rate for Payer: BCBS Trust/PPO |
$187.51
|
| Rate for Payer: BCN Commercial |
$187.51
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Advantage |
$35,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: Priority Health SBD |
$31,500.00
|
|
|
HC PERQ TRANSL REVASC CABG ARTERY/BRANCHES PCI
|
Facility
|
IP
|
$49,300.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100146
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$31,059.00 |
| Max. Negotiated Rate |
$44,370.00 |
| Rate for Payer: Aetna Commercial |
$41,905.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,045.00
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Advantage |
$34,510.00
|
| Rate for Payer: Cofinity Commercial |
$42,398.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Healthscope Commercial |
$44,370.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: PHP Commercial |
$41,905.00
|
| Rate for Payer: Priority Health SBD |
$31,059.00
|
|
|
HC PERQ TRANSL REVASC CABG ARTERY/BRANCHES PCI
|
Facility
|
OP
|
$49,300.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100146
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$562.58 |
| Max. Negotiated Rate |
$44,370.00 |
| Rate for Payer: Aetna Commercial |
$41,905.00
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,045.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$562.58
|
| Rate for Payer: BCN Commercial |
$562.58
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Advantage |
$34,510.00
|
| Rate for Payer: Cofinity Commercial |
$42,398.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$44,370.00
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$41,905.00
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$31,059.00
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100148
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,500.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$6,394.85
|
| Rate for Payer: BCN Commercial |
$6,394.85
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Advantage |
$35,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$31,500.00
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100148
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$31,500.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,500.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Advantage |
$35,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: Priority Health SBD |
$31,500.00
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE & RETROGRADE
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT 92945
|
| Hospital Charge Code |
48100151
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$31,500.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,500.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Advantage |
$35,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: Priority Health SBD |
$31,500.00
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE & RETROGRADE
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT 92945
|
| Hospital Charge Code |
48100151
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,500.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Advantage |
$35,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$31,500.00
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRANSLUM ATHERECTOMY ARTERY/BRANCHES
|
Facility
|
IP
|
$28,200.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100142
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,766.00 |
| Max. Negotiated Rate |
$25,380.00 |
| Rate for Payer: Aetna Commercial |
$23,970.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,330.00
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cofinity Advantage |
$19,740.00
|
| Rate for Payer: Cofinity Commercial |
$24,252.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,560.00
|
| Rate for Payer: Healthscope Commercial |
$25,380.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,970.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,150.00
|
| Rate for Payer: PHP Commercial |
$23,970.00
|
| Rate for Payer: Priority Health SBD |
$17,766.00
|
|
|
HC PERQ TRANSLUM ATHERECTOMY ARTERY/BRANCHES
|
Facility
|
OP
|
$28,200.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100142
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$178.73 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$23,970.00
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,330.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$178.73
|
| Rate for Payer: BCN Commercial |
$178.73
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cofinity Advantage |
$19,740.00
|
| Rate for Payer: Cofinity Commercial |
$24,252.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$25,380.00
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,970.00
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,150.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$23,970.00
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$17,766.00
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRANSLUM BALLOON ANGIO ARTERY/BRANCHES
|
Facility
|
IP
|
$18,900.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,907.00 |
| Max. Negotiated Rate |
$17,010.00 |
| Rate for Payer: Aetna Commercial |
$16,065.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,285.00
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cofinity Advantage |
$13,230.00
|
| Rate for Payer: Cofinity Commercial |
$16,254.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,120.00
|
| Rate for Payer: Healthscope Commercial |
$17,010.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,065.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,175.00
|
| Rate for Payer: PHP Commercial |
$16,065.00
|
| Rate for Payer: Priority Health SBD |
$11,907.00
|
|
|
HC PERQ TRANSLUM BALLOON ANGIO ARTERY/BRANCHES
|
Facility
|
OP
|
$18,900.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,965.99 |
| Max. Negotiated Rate |
$18,339.80 |
| Rate for Payer: Aetna Commercial |
$16,065.00
|
| Rate for Payer: Aetna Medicare |
$5,897.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,285.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,088.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,088.88
|
| Rate for Payer: BCBS Complete |
$3,114.57
|
| Rate for Payer: BCBS MAPPO |
$5,671.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,709.54
|
| Rate for Payer: BCN Commercial |
$3,709.54
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.10
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cofinity Advantage |
$13,230.00
|
| Rate for Payer: Cofinity Commercial |
$16,254.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.10
|
| Rate for Payer: Healthscope Commercial |
$17,010.00
|
| Rate for Payer: Mclaren Medicaid |
$2,965.99
|
| Rate for Payer: Mclaren Medicare |
$5,671.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,954.65
|
| Rate for Payer: Meridian Medicaid |
$5,954.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,521.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,238.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,065.00
|
| Rate for Payer: Nomi Health Commercial |
$17,013.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,175.00
|
| Rate for Payer: PACE Medicare |
$5,387.55
|
| Rate for Payer: PACE SWMI |
$5,671.10
|
| Rate for Payer: PHP Commercial |
$16,065.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,965.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,339.80
|
| Rate for Payer: Priority Health Medicare |
$5,671.10
|
| Rate for Payer: Priority Health SBD |
$11,907.00
|
| Rate for Payer: Priority Health Tiered Network |
$14,671.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,671.10
|
| Rate for Payer: UHC Medicaid |
$2,965.99
|
| Rate for Payer: UHCCP Medicaid |
$2,965.99
|
| Rate for Payer: VA VA |
$5,671.10
|
|
