|
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
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY
|
Facility
|
IP
|
$32,044.32
|
|
|
Service Code
|
CPT C9772
|
| Hospital Charge Code |
48100128
|
|
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 TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY
|
Facility
|
OP
|
$32,044.32
|
|
|
Service Code
|
CPT C9772
|
| Hospital Charge Code |
48100128
|
|
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 TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH ATHERECTOMY
|
Facility
|
OP
|
$51,052.43
|
|
|
Service Code
|
CPT C9774
|
| Hospital Charge Code |
48100130
|
|
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 TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH ATHERECTOMY
|
Facility
|
IP
|
$51,052.43
|
|
|
Service Code
|
CPT C9774
|
| Hospital Charge Code |
48100130
|
|
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 TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH STENT
|
Facility
|
IP
|
$51,052.43
|
|
|
Service Code
|
CPT C9773
|
| Hospital Charge Code |
48100129
|
|
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 TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH STENT
|
Facility
|
OP
|
$51,052.43
|
|
|
Service Code
|
CPT C9773
|
| Hospital Charge Code |
48100129
|
|
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 TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH STENT AND ATHERECT
|
Facility
|
OP
|
$51,052.43
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
48100131
|
|
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 TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH STENT AND ATHERECT
|
Facility
|
IP
|
$51,052.43
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
48100131
|
|
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 REVASCULARIZATION STENT FEM POP UNI
|
Facility
|
IP
|
$13,269.50
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
36100170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,359.78 |
| Max. Negotiated Rate |
$11,942.55 |
| Rate for Payer: Aetna Commercial |
$11,279.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,625.17
|
| Rate for Payer: Cash Price |
$10,615.60
|
| Rate for Payer: Cofinity Advantage |
$9,288.65
|
| Rate for Payer: Cofinity Commercial |
$11,411.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,615.60
|
| Rate for Payer: Healthscope Commercial |
$11,942.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,279.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,952.12
|
| Rate for Payer: PHP Commercial |
$11,279.08
|
| Rate for Payer: Priority Health SBD |
$8,359.78
|
|
|
HC REVASCULARIZATION STENT FEM POP UNI
|
Facility
|
OP
|
$13,269.50
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
36100170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,307.80 |
| Max. Negotiated Rate |
$11,942.55 |
| Rate for Payer: Aetna Commercial |
$11,279.08
|
| Rate for Payer: Aetna Medicare |
$6,634.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,625.17
|
| Rate for Payer: BCBS Complete |
$5,307.80
|
| Rate for Payer: BCBS Trust/PPO |
$7,092.26
|
| Rate for Payer: BCN Commercial |
$7,092.26
|
| Rate for Payer: Cash Price |
$10,615.60
|
| Rate for Payer: Cash Price |
$10,615.60
|
| Rate for Payer: Cofinity Advantage |
$9,288.65
|
| Rate for Payer: Cofinity Commercial |
$11,411.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,615.60
|
| Rate for Payer: Healthscope Commercial |
$11,942.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,615.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,279.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,952.12
|
| Rate for Payer: PHP Commercial |
$11,279.08
|
| Rate for Payer: Priority Health SBD |
$8,359.78
|
|
|
HC REVAS DES/CABG ADD.
|
Facility
|
OP
|
$19,483.94
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
48100084
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| 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 |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| 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 DES/CABG ADD.
|
Facility
|
IP
|
$19,483.94
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
48100084
|
|
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 DES/CABG INITIAL
|
Facility
|
IP
|
$29,741.77
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
48100083
|
|
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 DES/CABG INITIAL
|
Facility
|
OP
|
$29,741.77
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
48100083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| 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 |
$6,695.86
|
| Rate for Payer: BCN Commercial |
$6,695.86
|
| 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: 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 REVAS MI/DES
|
Facility
|
IP
|
$30,266.82
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
48100086
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$19,068.10 |
| Max. Negotiated Rate |
$27,240.14 |
| Rate for Payer: Aetna Commercial |
$25,726.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,673.43
|
| Rate for Payer: Cash Price |
$24,213.46
|
| Rate for Payer: Cofinity Advantage |
$21,186.77
|
| Rate for Payer: Cofinity Commercial |
$26,029.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,213.46
|
| Rate for Payer: Healthscope Commercial |
$27,240.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,726.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,700.12
|
| Rate for Payer: PHP Commercial |
$25,726.80
|
| Rate for Payer: Priority Health SBD |
$19,068.10
|
|
|
HC REVAS MI/DES
|
Facility
|
OP
|
$30,266.82
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
48100086
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,149.17 |
| Max. Negotiated Rate |
$27,240.14 |
| Rate for Payer: Aetna Commercial |
$25,726.80
|
| Rate for Payer: Aetna Medicare |
$15,133.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,673.43
|
| Rate for Payer: BCBS Complete |
$12,106.73
|
| Rate for Payer: BCBS Trust/PPO |
$10,149.17
|
| Rate for Payer: BCN Commercial |
$10,149.17
|
| Rate for Payer: Cash Price |
$24,213.46
|
| Rate for Payer: Cash Price |
$24,213.46
|
| Rate for Payer: Cofinity Advantage |
$21,186.77
|
| Rate for Payer: Cofinity Commercial |
$26,029.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,213.46
|
| Rate for Payer: Healthscope Commercial |
$27,240.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,213.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,726.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,700.12
|
| Rate for Payer: PHP Commercial |
$25,726.80
|
| Rate for Payer: Priority Health SBD |
$19,068.10
|
|
|
HC REVAS MI/STENT
|
Facility
|
OP
|
$30,266.82
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$187.51 |
| Max. Negotiated Rate |
$27,240.14 |
| Rate for Payer: Aetna Commercial |
$25,726.80
|
| Rate for Payer: Aetna Medicare |
$15,133.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,673.43
|
| Rate for Payer: BCBS Complete |
$12,106.73
|
| Rate for Payer: BCBS Trust/PPO |
$187.51
|
| Rate for Payer: BCN Commercial |
$187.51
|
| Rate for Payer: Cash Price |
$24,213.46
|
| Rate for Payer: Cash Price |
$24,213.46
|
| Rate for Payer: Cofinity Advantage |
$21,186.77
|
| Rate for Payer: Cofinity Commercial |
$26,029.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,213.46
|
| Rate for Payer: Healthscope Commercial |
$27,240.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,213.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,726.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,700.12
|
| Rate for Payer: PHP Commercial |
$25,726.80
|
| Rate for Payer: Priority Health SBD |
$19,068.10
|
|
|
HC REVAS MI/STENT
|
Facility
|
IP
|
$30,266.82
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$19,068.10 |
| Max. Negotiated Rate |
$27,240.14 |
| Rate for Payer: Aetna Commercial |
$25,726.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,673.43
|
| Rate for Payer: Cash Price |
$24,213.46
|
| Rate for Payer: Cofinity Advantage |
$21,186.77
|
| Rate for Payer: Cofinity Commercial |
$26,029.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,213.46
|
| Rate for Payer: Healthscope Commercial |
$27,240.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,726.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,700.12
|
| Rate for Payer: PHP Commercial |
$25,726.80
|
| Rate for Payer: Priority Health SBD |
$19,068.10
|
|
|
HC REVISE/REPLACE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
IP
|
$16,344.72
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
36100612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,297.17 |
| Max. Negotiated Rate |
$14,710.25 |
| Rate for Payer: Aetna Commercial |
$13,893.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,624.07
|
| Rate for Payer: Cash Price |
$13,075.78
|
| Rate for Payer: Cofinity Advantage |
$11,441.30
|
| Rate for Payer: Cofinity Commercial |
$14,056.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,075.78
|
| Rate for Payer: Healthscope Commercial |
$14,710.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,893.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,258.54
|
| Rate for Payer: PHP Commercial |
$13,893.01
|
| Rate for Payer: Priority Health SBD |
$10,297.17
|
|
|
HC REVISE/REPLACE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
OP
|
$16,344.72
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
36100612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,321.09 |
| Max. Negotiated Rate |
$20,535.59 |
| Rate for Payer: Aetna Commercial |
$13,893.01
|
| Rate for Payer: Aetna Medicare |
$6,604.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,624.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,937.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,937.60
|
| Rate for Payer: BCBS Complete |
$3,487.46
|
| Rate for Payer: BCBS MAPPO |
$6,350.08
|
| Rate for Payer: BCBS Trust/PPO |
$4,820.83
|
| Rate for Payer: BCN Commercial |
$4,820.83
|
| Rate for Payer: BCN Medicare Advantage |
$6,350.08
|
| Rate for Payer: Cash Price |
$13,075.78
|
| Rate for Payer: Cash Price |
$13,075.78
|
| Rate for Payer: Cash Price |
$13,075.78
|
| Rate for Payer: Cofinity Advantage |
$11,441.30
|
| Rate for Payer: Cofinity Commercial |
$14,056.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,075.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,350.08
|
| Rate for Payer: Healthscope Commercial |
$14,710.25
|
| Rate for Payer: Mclaren Medicaid |
$3,321.09
|
| Rate for Payer: Mclaren Medicare |
$6,350.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,667.58
|
| Rate for Payer: Meridian Medicaid |
$6,667.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,302.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,985.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,893.01
|
| Rate for Payer: Nomi Health Commercial |
$19,050.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,258.54
|
| Rate for Payer: PACE Medicare |
$6,032.58
|
| Rate for Payer: PACE SWMI |
$6,350.08
|
| Rate for Payer: PHP Commercial |
$13,893.01
|
| Rate for Payer: PHP Medicare Advantage |
$6,350.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,321.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,535.59
|
| Rate for Payer: Priority Health Medicare |
$6,350.08
|
| Rate for Payer: Priority Health SBD |
$10,297.17
|
| Rate for Payer: Priority Health Tiered Network |
$16,428.47
|
| Rate for Payer: Railroad Medicare Medicare |
$6,350.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,350.08
|
| Rate for Payer: UHC Medicaid |
$3,321.09
|
| Rate for Payer: UHCCP Medicaid |
$3,321.09
|
| Rate for Payer: VA VA |
$6,350.08
|
|
|
HC REZUM DELIVERY DEVICE
|
Facility
|
OP
|
$3,173.22
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$2,855.90 |
| Rate for Payer: Aetna Commercial |
$2,697.24
|
| Rate for Payer: Aetna Medicare |
$1,586.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,062.59
|
| Rate for Payer: BCBS Complete |
$1,269.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$2,538.58
|
| Rate for Payer: Cash Price |
$2,538.58
|
| Rate for Payer: Cofinity Advantage |
$2,221.25
|
| Rate for Payer: Cofinity Commercial |
$2,728.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,538.58
|
| Rate for Payer: Healthscope Commercial |
$2,855.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,538.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,697.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,379.91
|
| Rate for Payer: PHP Commercial |
$2,697.24
|
| Rate for Payer: Priority Health SBD |
$1,999.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,062.59
|
| Rate for Payer: UHC Core |
$1,653.25
|
| Rate for Payer: UHC Exchange |
$1,247.08
|
|
|
HC REZUM DELIVERY DEVICE
|
Facility
|
IP
|
$3,173.22
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.13 |
| Max. Negotiated Rate |
$2,855.90 |
| Rate for Payer: Aetna Commercial |
$2,697.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,062.59
|
| Rate for Payer: Cash Price |
$2,538.58
|
| Rate for Payer: Cofinity Advantage |
$2,221.25
|
| Rate for Payer: Cofinity Commercial |
$2,728.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,538.58
|
| Rate for Payer: Healthscope Commercial |
$2,855.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,697.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,379.91
|
| Rate for Payer: PHP Commercial |
$2,697.24
|
| Rate for Payer: Priority Health SBD |
$1,999.13
|
|
|
HC RF ABLATION KIDNEY TUMOR
|
Facility
|
OP
|
$7,935.33
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
36100247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,015.30 |
| Max. Negotiated Rate |
$19,480.40 |
| Rate for Payer: Aetna Commercial |
$6,745.03
|
| Rate for Payer: Aetna Medicare |
$6,264.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,157.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$3,015.30
|
| Rate for Payer: BCN Commercial |
$3,015.30
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Cash Price |
$6,348.26
|
| Rate for Payer: Cash Price |
$6,348.26
|
| Rate for Payer: Cash Price |
$6,348.26
|
| Rate for Payer: Cofinity Advantage |
$5,554.73
|
| Rate for Payer: Cofinity Commercial |
$6,824.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,348.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Healthscope Commercial |
$7,141.80
|
| Rate for Payer: Mclaren Medicaid |
$3,150.44
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$6,324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,745.03
|
| Rate for Payer: Nomi Health Commercial |
$18,071.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,951.50
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Commercial |
$6,745.03
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,480.40
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health SBD |
$4,999.26
|
| Rate for Payer: Priority Health Tiered Network |
$15,584.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
|
HC RF ABLATION KIDNEY TUMOR
|
Facility
|
IP
|
$7,935.33
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
36100247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,999.26 |
| Max. Negotiated Rate |
$7,141.80 |
| Rate for Payer: Aetna Commercial |
$6,745.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,157.96
|
| Rate for Payer: Cash Price |
$6,348.26
|
| Rate for Payer: Cofinity Advantage |
$5,554.73
|
| Rate for Payer: Cofinity Commercial |
$6,824.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,348.26
|
| Rate for Payer: Healthscope Commercial |
$7,141.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,745.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,951.50
|
| Rate for Payer: PHP Commercial |
$6,745.03
|
| Rate for Payer: Priority Health SBD |
$4,999.26
|
|
