|
HC RESP VIRAL PANEL RP2.1
|
Facility
|
OP
|
$636.72
|
|
|
Service Code
|
HCPCS 0202U
|
| Hospital Charge Code |
30000162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$213.24 |
| Max. Negotiated Rate |
$1,250.34 |
| Rate for Payer: Aetna Commercial |
$541.21
|
| Rate for Payer: Aetna Medicare |
$433.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: BCBS Complete |
$228.90
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$213.24
|
| Rate for Payer: BCN Commercial |
$213.24
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$509.38
|
| Rate for Payer: Cash Price |
$509.38
|
| Rate for Payer: Cofinity Advantage |
$445.70
|
| Rate for Payer: Cofinity Commercial |
$547.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$573.05
|
| Rate for Payer: Mclaren Medicaid |
$217.98
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: Meridian Medicaid |
$437.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$458.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.21
|
| Rate for Payer: Nomi Health Commercial |
$1,250.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.54
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$541.21
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$416.78
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health SBD |
$401.13
|
| Rate for Payer: Priority Health Tiered Network |
$333.42
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.17
|
| Rate for Payer: UHC Core |
$625.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$416.78
|
| Rate for Payer: UHC Exchange |
$625.17
|
| Rate for Payer: UHC Medicaid |
$217.98
|
| Rate for Payer: UHCCP Medicaid |
$217.98
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC RESP VIRAL PANEL RP2.1
|
Facility
|
IP
|
$636.72
|
|
|
Service Code
|
HCPCS 0202U
|
| Hospital Charge Code |
30000162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$401.13 |
| Max. Negotiated Rate |
$573.05 |
| Rate for Payer: Aetna Commercial |
$541.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.87
|
| Rate for Payer: Cash Price |
$509.38
|
| Rate for Payer: Cofinity Advantage |
$445.70
|
| Rate for Payer: Cofinity Commercial |
$547.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.38
|
| Rate for Payer: Healthscope Commercial |
$573.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.54
|
| Rate for Payer: PHP Commercial |
$541.21
|
| Rate for Payer: Priority Health SBD |
$401.13
|
|
|
HC RESTORE HYDROGEL 3 OZ
|
Facility
|
OP
|
$19.23
|
|
| Hospital Charge Code |
27100015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$17.31 |
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Medicare |
$9.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.50
|
| Rate for Payer: BCBS Complete |
$7.69
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cofinity Advantage |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$16.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Healthscope Commercial |
$17.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.42
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: Priority Health SBD |
$12.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.50
|
| Rate for Payer: UHC Core |
$10.02
|
| Rate for Payer: UHC Exchange |
$7.56
|
|
|
HC RESTORE HYDROGEL 3 OZ
|
Facility
|
IP
|
$19.23
|
|
| Hospital Charge Code |
27100015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$17.31 |
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.50
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cofinity Advantage |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$16.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Healthscope Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.42
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: Priority Health SBD |
$12.11
|
|
|
HC RESUPERF WND BODY <2.5 CM
|
Facility
|
OP
|
$281.22
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
76100181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.76 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$239.04
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$102.76
|
| Rate for Payer: BCN Commercial |
$102.76
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$224.98
|
| Rate for Payer: Cash Price |
$224.98
|
| Rate for Payer: Cash Price |
$224.98
|
| Rate for Payer: Cofinity Advantage |
$196.85
|
| Rate for Payer: Cofinity Commercial |
$241.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$253.10
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.04
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.91
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$239.04
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$177.17
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.79
|
| Rate for Payer: UHC Core |
$146.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$110.52
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC RESUPERF WND BODY <2.5 CM
|
Facility
|
IP
|
$281.22
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
76100181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.17 |
| Max. Negotiated Rate |
$253.10 |
| Rate for Payer: Aetna Commercial |
$239.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.79
|
| Rate for Payer: Cash Price |
$224.98
|
| Rate for Payer: Cofinity Advantage |
$196.85
|
| Rate for Payer: Cofinity Commercial |
$241.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.98
|
| Rate for Payer: Healthscope Commercial |
$253.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.91
|
| Rate for Payer: PHP Commercial |
$239.04
|
| Rate for Payer: Priority Health SBD |
$177.17
|
|
|
HC RETICULOCYTE COUNT
|
Facility
|
OP
|
$42.34
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
30500010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$38.11 |
| Rate for Payer: Aetna Commercial |
$35.99
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.94
|
| Rate for Payer: BCN Commercial |
$5.94
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$33.87
|
| Rate for Payer: Cash Price |
$33.87
|
| Rate for Payer: Cofinity Advantage |
$29.64
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$38.11
|
| Rate for Payer: Mclaren Medicaid |
$2.91
|
| Rate for Payer: Mclaren Medicare |
$5.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: Meridian Medicaid |
$5.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.99
|
| Rate for Payer: Nomi Health Commercial |
$8.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.75
|
| Rate for Payer: PACE Medicare |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$35.99
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.57
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health SBD |
$26.67
|
| Rate for Payer: Priority Health Tiered Network |
$4.46
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.36
|
| Rate for Payer: UHC Core |
$8.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.57
|
| Rate for Payer: UHC Exchange |
$8.36
|
| Rate for Payer: UHC Medicaid |
$2.91
|
| Rate for Payer: UHCCP Medicaid |
$2.91
|
| Rate for Payer: VA VA |
$5.57
|
|
|
HC RETICULOCYTE COUNT
|
Facility
|
IP
|
$42.34
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
30500010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.67 |
| Max. Negotiated Rate |
$38.11 |
| Rate for Payer: Aetna Commercial |
$35.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.52
|
| Rate for Payer: Cash Price |
$33.87
|
| Rate for Payer: Cofinity Advantage |
$29.64
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.87
|
| Rate for Payer: Healthscope Commercial |
$38.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.75
|
| Rate for Payer: PHP Commercial |
$35.99
|
| Rate for Payer: Priority Health SBD |
$26.67
|
|
|
HC REVAS ADD.VESSEL/DES
|
Facility
|
IP
|
$19,739.22
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,435.71 |
| Max. Negotiated Rate |
$17,765.30 |
| Rate for Payer: Aetna Commercial |
$16,778.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,830.49
|
| Rate for Payer: Cash Price |
$15,791.38
|
| Rate for Payer: Cofinity Advantage |
$13,817.45
|
| Rate for Payer: Cofinity Commercial |
$16,975.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,791.38
|
| Rate for Payer: Healthscope Commercial |
$17,765.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,778.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,804.42
|
| Rate for Payer: PHP Commercial |
$16,778.34
|
| Rate for Payer: Priority Health SBD |
$12,435.71
|
|
|
HC REVAS ADD.VESSEL/DES
|
Facility
|
OP
|
$19,739.22
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$17,765.30 |
| Rate for Payer: Aetna Commercial |
$16,778.34
|
| Rate for Payer: Aetna Medicare |
$9,869.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,830.49
|
| Rate for Payer: BCBS Complete |
$7,895.69
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$15,791.38
|
| Rate for Payer: Cash Price |
$15,791.38
|
| Rate for Payer: Cofinity Advantage |
$13,817.45
|
| Rate for Payer: Cofinity Commercial |
$16,975.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,791.38
|
| Rate for Payer: Healthscope Commercial |
$17,765.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,791.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,778.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,804.42
|
| Rate for Payer: PHP Commercial |
$16,778.34
|
| Rate for Payer: Priority Health SBD |
$12,435.71
|
|
|
HC REVAS ADD.VESSEL/STENT
|
Facility
|
OP
|
$19,739.22
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$229.30 |
| Max. Negotiated Rate |
$17,765.30 |
| Rate for Payer: Aetna Commercial |
$16,778.34
|
| Rate for Payer: Aetna Medicare |
$9,869.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,830.49
|
| Rate for Payer: BCBS Complete |
$7,895.69
|
| Rate for Payer: BCBS Trust/PPO |
$229.30
|
| Rate for Payer: BCN Commercial |
$229.30
|
| Rate for Payer: Cash Price |
$15,791.38
|
| Rate for Payer: Cash Price |
$15,791.38
|
| Rate for Payer: Cofinity Advantage |
$13,817.45
|
| Rate for Payer: Cofinity Commercial |
$16,975.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,791.38
|
| Rate for Payer: Healthscope Commercial |
$17,765.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,791.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,778.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,804.42
|
| Rate for Payer: PHP Commercial |
$16,778.34
|
| Rate for Payer: Priority Health SBD |
$12,435.71
|
|
|
HC REVAS ADD.VESSEL/STENT
|
Facility
|
IP
|
$19,739.22
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,435.71 |
| Max. Negotiated Rate |
$17,765.30 |
| Rate for Payer: Aetna Commercial |
$16,778.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,830.49
|
| Rate for Payer: Cash Price |
$15,791.38
|
| Rate for Payer: Cofinity Advantage |
$13,817.45
|
| Rate for Payer: Cofinity Commercial |
$16,975.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,791.38
|
| Rate for Payer: Healthscope Commercial |
$17,765.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,778.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,804.42
|
| Rate for Payer: PHP Commercial |
$16,778.34
|
| Rate for Payer: Priority Health SBD |
$12,435.71
|
|
|
HC REVAS CABG ADD.BRANCH
|
Facility
|
OP
|
$19,483.94
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
48100082
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$687.53 |
| Max. Negotiated Rate |
$17,535.55 |
| Rate for Payer: Aetna Commercial |
$16,561.35
|
| Rate for Payer: Aetna Medicare |
$9,741.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,664.56
|
| Rate for Payer: BCBS Complete |
$7,793.58
|
| Rate for Payer: BCBS Trust/PPO |
$687.53
|
| Rate for Payer: BCN Commercial |
$687.53
|
| Rate for Payer: Cash Price |
$15,587.15
|
| Rate for Payer: Cash Price |
$15,587.15
|
| Rate for Payer: Cofinity Advantage |
$13,638.76
|
| Rate for Payer: Cofinity Commercial |
$16,756.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,587.15
|
| Rate for Payer: Healthscope Commercial |
$17,535.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,587.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,561.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,612.95
|
| Rate for Payer: PHP Commercial |
$16,561.35
|
| Rate for Payer: Priority Health SBD |
$12,274.88
|
|
|
HC REVAS CABG ADD.BRANCH
|
Facility
|
IP
|
$19,483.94
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
48100082
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,274.88 |
| Max. Negotiated Rate |
$17,535.55 |
| Rate for Payer: Aetna Commercial |
$16,561.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,664.56
|
| Rate for Payer: Cash Price |
$15,587.15
|
| Rate for Payer: Cofinity Advantage |
$13,638.76
|
| Rate for Payer: Cofinity Commercial |
$16,756.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,587.15
|
| Rate for Payer: Healthscope Commercial |
$17,535.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,561.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,612.95
|
| Rate for Payer: PHP Commercial |
$16,561.35
|
| Rate for Payer: Priority Health SBD |
$12,274.88
|
|
|
HC REVAS CABG VES/BRANCH
|
Facility
|
IP
|
$29,741.77
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,737.32 |
| Max. Negotiated Rate |
$26,767.59 |
| Rate for Payer: Aetna Commercial |
$25,280.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,332.15
|
| Rate for Payer: Cash Price |
$23,793.42
|
| Rate for Payer: Cofinity Advantage |
$20,819.24
|
| Rate for Payer: Cofinity Commercial |
$25,577.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,793.42
|
| Rate for Payer: Healthscope Commercial |
$26,767.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,280.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,306.33
|
| Rate for Payer: PHP Commercial |
$25,280.50
|
| Rate for Payer: Priority Health SBD |
$18,737.32
|
|
|
HC REVAS CABG VES/BRANCH
|
Facility
|
OP
|
$29,741.77
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$562.58 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$25,280.50
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,332.15
|
| 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 |
$23,793.42
|
| Rate for Payer: Cash Price |
$23,793.42
|
| Rate for Payer: Cofinity Advantage |
$20,819.24
|
| Rate for Payer: Cofinity Commercial |
$25,577.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,793.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$26,767.59
|
| 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 |
$25,280.50
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,306.33
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$25,280.50
|
| 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 |
$18,737.32
|
| 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 REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY
|
Facility
|
IP
|
$32,044.32
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
48100124
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$20,187.92 |
| Max. Negotiated Rate |
$28,839.89 |
| Rate for Payer: Aetna Commercial |
$27,237.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,828.81
|
| Rate for Payer: Cash Price |
$25,635.46
|
| Rate for Payer: Cofinity Advantage |
$22,431.02
|
| Rate for Payer: Cofinity Commercial |
$27,558.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,635.46
|
| Rate for Payer: Healthscope Commercial |
$28,839.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,237.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24,033.24
|
| Rate for Payer: PHP Commercial |
$27,237.67
|
| Rate for Payer: Priority Health SBD |
$20,187.92
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY
|
Facility
|
OP
|
$32,044.32
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
48100124
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$27,237.67
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,828.81
|
| 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 |
$25,635.46
|
| Rate for Payer: Cash Price |
$25,635.46
|
| Rate for Payer: Cofinity Advantage |
$22,431.02
|
| Rate for Payer: Cofinity Commercial |
$27,558.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,635.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$28,839.89
|
| 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 |
$27,237.67
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24,033.24
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$27,237.67
|
| 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 |
$20,187.92
|
| 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 REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH ATHERECTOMY
|
Facility
|
IP
|
$51,052.43
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
48100126
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$32,163.03 |
| Max. Negotiated Rate |
$45,947.19 |
| Rate for Payer: Aetna Commercial |
$43,394.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,184.08
|
| Rate for Payer: Cash Price |
$40,841.94
|
| Rate for Payer: Cofinity Advantage |
$35,736.70
|
| Rate for Payer: Cofinity Commercial |
$43,905.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,841.94
|
| Rate for Payer: Healthscope Commercial |
$45,947.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,394.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,289.32
|
| Rate for Payer: PHP Commercial |
$43,394.57
|
| Rate for Payer: Priority Health SBD |
$32,163.03
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH ATHERECTOMY
|
Facility
|
OP
|
$51,052.43
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
48100126
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,552.97 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$43,394.57
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,184.08
|
| 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 |
$40,841.94
|
| Rate for Payer: Cash Price |
$40,841.94
|
| Rate for Payer: Cofinity Advantage |
$35,736.70
|
| Rate for Payer: Cofinity Commercial |
$43,905.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,841.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$45,947.19
|
| 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 |
$43,394.57
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,289.32
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$43,394.57
|
| 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 |
$32,163.03
|
| 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 REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH STENT
|
Facility
|
IP
|
$51,052.43
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
48100125
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$32,163.03 |
| Max. Negotiated Rate |
$45,947.19 |
| Rate for Payer: Aetna Commercial |
$43,394.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,184.08
|
| Rate for Payer: Cash Price |
$40,841.94
|
| Rate for Payer: Cofinity Advantage |
$35,736.70
|
| Rate for Payer: Cofinity Commercial |
$43,905.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,841.94
|
| Rate for Payer: Healthscope Commercial |
$45,947.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,394.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,289.32
|
| Rate for Payer: PHP Commercial |
$43,394.57
|
| Rate for Payer: Priority Health SBD |
$32,163.03
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH STENT
|
Facility
|
OP
|
$51,052.43
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
48100125
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,552.97 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$43,394.57
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,184.08
|
| 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 |
$40,841.94
|
| Rate for Payer: Cash Price |
$40,841.94
|
| Rate for Payer: Cofinity Advantage |
$35,736.70
|
| Rate for Payer: Cofinity Commercial |
$43,905.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,841.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$45,947.19
|
| 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 |
$43,394.57
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,289.32
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$43,394.57
|
| 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 |
$32,163.03
|
| 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 REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH STENT AND ATHERECT
|
Facility
|
IP
|
$51,052.43
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
48100127
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$32,163.03 |
| Max. Negotiated Rate |
$45,947.19 |
| Rate for Payer: Aetna Commercial |
$43,394.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,184.08
|
| Rate for Payer: Cash Price |
$40,841.94
|
| Rate for Payer: Cofinity Advantage |
$35,736.70
|
| Rate for Payer: Cofinity Commercial |
$43,905.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,841.94
|
| Rate for Payer: Healthscope Commercial |
$45,947.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,394.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,289.32
|
| Rate for Payer: PHP Commercial |
$43,394.57
|
| Rate for Payer: Priority Health SBD |
$32,163.03
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH STENT AND ATHERECT
|
Facility
|
OP
|
$51,052.43
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
48100127
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,552.97 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$43,394.57
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33,184.08
|
| 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 |
$40,841.94
|
| Rate for Payer: Cash Price |
$40,841.94
|
| Rate for Payer: Cofinity Advantage |
$35,736.70
|
| Rate for Payer: Cofinity Commercial |
$43,905.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,841.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$45,947.19
|
| 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 |
$43,394.57
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38,289.32
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$43,394.57
|
| 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 |
$32,163.03
|
| 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 REVASC STENT TIB PERONL UNI INITIAL
|
Facility
|
IP
|
$12,063.19
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
36100174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,599.81 |
| Max. Negotiated Rate |
$10,856.87 |
| Rate for Payer: Aetna Commercial |
$10,253.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,841.07
|
| Rate for Payer: Cash Price |
$9,650.55
|
| Rate for Payer: Cofinity Advantage |
$8,444.23
|
| Rate for Payer: Cofinity Commercial |
$10,374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,650.55
|
| Rate for Payer: Healthscope Commercial |
$10,856.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,253.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,047.39
|
| Rate for Payer: PHP Commercial |
$10,253.71
|
| Rate for Payer: Priority Health SBD |
$7,599.81
|
|
