|
HC REVASC STENT TIB PERONL UNI INITIAL
|
Facility
|
IP
|
$11,826.66
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
36100174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,450.80 |
| Max. Negotiated Rate |
$10,643.99 |
| Rate for Payer: Aetna Commercial |
$10,052.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,687.33
|
| Rate for Payer: Cash Price |
$9,461.33
|
| Rate for Payer: Cofinity Commercial |
$10,170.93
|
| Rate for Payer: Cofinity Commercial |
$8,278.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,278.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,461.33
|
| Rate for Payer: Healthscope Commercial |
$10,643.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,052.66
|
| Rate for Payer: PHP Commercial |
$10,052.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,687.33
|
| Rate for Payer: Priority Health SBD |
$7,450.80
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY
|
Facility
|
OP
|
$31,416.00
|
|
|
Service Code
|
CPT C9772
|
| Hospital Charge Code |
48100128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$26,703.60
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,420.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cofinity Commercial |
$27,017.76
|
| Rate for Payer: Cofinity Commercial |
$21,991.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,991.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,132.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$28,274.40
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,703.60
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$26,703.60
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,420.40
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$19,792.08
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,133.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$6,226.91
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY
|
Facility
|
IP
|
$31,416.00
|
|
|
Service Code
|
CPT C9772
|
| Hospital Charge Code |
48100128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$19,792.08 |
| Max. Negotiated Rate |
$28,274.40 |
| Rate for Payer: Aetna Commercial |
$26,703.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,420.40
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cofinity Commercial |
$21,991.20
|
| Rate for Payer: Cofinity Commercial |
$27,017.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,991.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,132.80
|
| Rate for Payer: Healthscope Commercial |
$28,274.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,703.60
|
| Rate for Payer: PHP Commercial |
$26,703.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,420.40
|
| Rate for Payer: Priority Health SBD |
$19,792.08
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH ATHERECTOMY
|
Facility
|
OP
|
$50,051.40
|
|
|
Service Code
|
CPT C9774
|
| Hospital Charge Code |
48100130
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,296.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,859.72
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH ATHERECTOMY
|
Facility
|
IP
|
$50,051.40
|
|
|
Service Code
|
CPT C9774
|
| Hospital Charge Code |
48100130
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$31,532.38 |
| Max. Negotiated Rate |
$45,046.26 |
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH STENT
|
Facility
|
IP
|
$50,051.40
|
|
|
Service Code
|
CPT C9773
|
| Hospital Charge Code |
48100129
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$31,532.38 |
| Max. Negotiated Rate |
$45,046.26 |
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH STENT
|
Facility
|
OP
|
$50,051.40
|
|
|
Service Code
|
CPT C9773
|
| Hospital Charge Code |
48100129
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,296.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,859.72
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH STENT AND ATHERECT
|
Facility
|
OP
|
$50,051.40
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
48100131
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,296.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,859.72
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH STENT AND ATHERECT
|
Facility
|
IP
|
$50,051.40
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
48100131
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$31,532.38 |
| Max. Negotiated Rate |
$45,046.26 |
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
|
|
HC REVASCULARIZATION STENT FEM POP UNI
|
Facility
|
OP
|
$13,009.31
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
36100170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$11,057.91
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,456.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Cash Price |
$10,407.45
|
| Rate for Payer: Cash Price |
$10,407.45
|
| Rate for Payer: Cofinity Commercial |
$9,106.52
|
| Rate for Payer: Cofinity Commercial |
$11,188.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,106.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,407.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$11,708.38
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,057.91
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$11,057.91
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,456.05
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$8,195.87
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,133.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$6,226.91
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
HC REVASCULARIZATION STENT FEM POP UNI
|
Facility
|
IP
|
$13,009.31
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
36100170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,195.87 |
| Max. Negotiated Rate |
$11,708.38 |
| Rate for Payer: Aetna Commercial |
$11,057.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,456.05
|
| Rate for Payer: Cash Price |
$10,407.45
|
| Rate for Payer: Cofinity Commercial |
$11,188.01
|
| Rate for Payer: Cofinity Commercial |
$9,106.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,106.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,407.45
|
| Rate for Payer: Healthscope Commercial |
$11,708.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,057.91
|
| Rate for Payer: PHP Commercial |
$11,057.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,456.05
|
| Rate for Payer: Priority Health SBD |
$8,195.87
|
|
|
HC REVAS DES/CABG ADD.
|
Facility
|
OP
|
$19,101.90
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
48100084
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,640.76 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna Commercial |
$16,236.61
|
| Rate for Payer: Aetna Medicare |
$9,550.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,416.24
|
| Rate for Payer: BCBS Complete |
$7,640.76
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$13,371.33
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,371.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.61
|
| Rate for Payer: PHP Commercial |
$16,236.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health SBD |
$12,034.20
|
|
|
HC REVAS DES/CABG ADD.
|
Facility
|
IP
|
$19,101.90
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
48100084
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,034.20 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna Commercial |
$16,236.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,416.24
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$13,371.33
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,371.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.61
|
| Rate for Payer: PHP Commercial |
$16,236.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health SBD |
$12,034.20
|
|
|
HC REVAS DES/CABG INITIAL
|
Facility
|
OP
|
$29,158.60
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
48100083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,953.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$20,411.02
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,411.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$18,369.92
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,133.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$6,226.91
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
HC REVAS DES/CABG INITIAL
|
Facility
|
IP
|
$29,158.60
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
48100083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,369.92 |
| Max. Negotiated Rate |
$26,242.74 |
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,953.09
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$20,411.02
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,411.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health SBD |
$18,369.92
|
|
|
HC REVAS MI/DES
|
Facility
|
IP
|
$29,673.35
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
48100086
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,694.21 |
| Max. Negotiated Rate |
$26,706.01 |
| Rate for Payer: Aetna Commercial |
$25,222.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,287.68
|
| Rate for Payer: Cash Price |
$23,738.68
|
| Rate for Payer: Cofinity Commercial |
$20,771.35
|
| Rate for Payer: Cofinity Commercial |
$25,519.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,771.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,738.68
|
| Rate for Payer: Healthscope Commercial |
$26,706.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,222.35
|
| Rate for Payer: PHP Commercial |
$25,222.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,287.68
|
| Rate for Payer: Priority Health SBD |
$18,694.21
|
|
|
HC REVAS MI/DES
|
Facility
|
OP
|
$29,673.35
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
48100086
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,869.34 |
| Max. Negotiated Rate |
$26,706.01 |
| Rate for Payer: Aetna Commercial |
$25,222.35
|
| Rate for Payer: Aetna Medicare |
$14,836.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,287.68
|
| Rate for Payer: BCBS Complete |
$11,869.34
|
| Rate for Payer: Cash Price |
$23,738.68
|
| Rate for Payer: Cofinity Commercial |
$20,771.35
|
| Rate for Payer: Cofinity Commercial |
$25,519.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,771.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,738.68
|
| Rate for Payer: Healthscope Commercial |
$26,706.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,222.35
|
| Rate for Payer: PHP Commercial |
$25,222.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,287.68
|
| Rate for Payer: Priority Health SBD |
$18,694.21
|
|
|
HC REVAS MI/STENT
|
Facility
|
OP
|
$29,673.35
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,869.34 |
| Max. Negotiated Rate |
$26,706.01 |
| Rate for Payer: Aetna Commercial |
$25,222.35
|
| Rate for Payer: Aetna Medicare |
$14,836.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,287.68
|
| Rate for Payer: BCBS Complete |
$11,869.34
|
| Rate for Payer: Cash Price |
$23,738.68
|
| Rate for Payer: Cofinity Commercial |
$20,771.35
|
| Rate for Payer: Cofinity Commercial |
$25,519.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,771.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,738.68
|
| Rate for Payer: Healthscope Commercial |
$26,706.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,222.35
|
| Rate for Payer: PHP Commercial |
$25,222.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,287.68
|
| Rate for Payer: Priority Health SBD |
$18,694.21
|
|
|
HC REVAS MI/STENT
|
Facility
|
IP
|
$29,673.35
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,694.21 |
| Max. Negotiated Rate |
$26,706.01 |
| Rate for Payer: Aetna Commercial |
$25,222.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,287.68
|
| Rate for Payer: Cash Price |
$23,738.68
|
| Rate for Payer: Cofinity Commercial |
$20,771.35
|
| Rate for Payer: Cofinity Commercial |
$25,519.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,771.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,738.68
|
| Rate for Payer: Healthscope Commercial |
$26,706.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,222.35
|
| Rate for Payer: PHP Commercial |
$25,222.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,287.68
|
| Rate for Payer: Priority Health SBD |
$18,694.21
|
|
|
HC REVISE/REPLACE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
OP
|
$16,024.24
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
36100612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,430.76 |
| Max. Negotiated Rate |
$18,017.25 |
| Rate for Payer: Aetna Commercial |
$13,620.60
|
| Rate for Payer: Aetna Medicare |
$6,656.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,415.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,000.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,000.84
|
| Rate for Payer: BCBS Complete |
$3,602.30
|
| Rate for Payer: BCBS MAPPO |
$6,400.67
|
| Rate for Payer: BCN Medicare Advantage |
$6,400.67
|
| Rate for Payer: Cash Price |
$12,819.39
|
| Rate for Payer: Cash Price |
$12,819.39
|
| Rate for Payer: Cofinity Commercial |
$13,780.85
|
| Rate for Payer: Cofinity Commercial |
$11,216.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,216.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,819.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,400.67
|
| Rate for Payer: Healthscope Commercial |
$14,421.82
|
| Rate for Payer: Mclaren Medicaid |
$3,430.76
|
| Rate for Payer: Mclaren Medicare |
$6,400.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,720.70
|
| Rate for Payer: Meridian Medicaid |
$3,602.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,360.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,620.60
|
| Rate for Payer: PACE Medicare |
$6,080.64
|
| Rate for Payer: PACE SWMI |
$6,400.67
|
| Rate for Payer: PHP Commercial |
$13,620.60
|
| Rate for Payer: PHP Medicare Advantage |
$6,400.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,430.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,415.76
|
| Rate for Payer: Priority Health Medicare |
$6,400.67
|
| Rate for Payer: Priority Health SBD |
$10,095.27
|
| Rate for Payer: Railroad Medicare Medicare |
$6,400.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,017.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,400.67
|
| Rate for Payer: UHC Medicare Advantage |
$6,400.67
|
| Rate for Payer: UHCCP Medicaid |
$3,603.58
|
| Rate for Payer: VA VA |
$6,400.67
|
|
|
HC REVISE/REPLACE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
IP
|
$16,024.24
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
36100612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,095.27 |
| Max. Negotiated Rate |
$14,421.82 |
| Rate for Payer: Aetna Commercial |
$13,620.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,415.76
|
| Rate for Payer: Cash Price |
$12,819.39
|
| Rate for Payer: Cofinity Commercial |
$11,216.97
|
| Rate for Payer: Cofinity Commercial |
$13,780.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,216.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,819.39
|
| Rate for Payer: Healthscope Commercial |
$14,421.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,620.60
|
| Rate for Payer: PHP Commercial |
$13,620.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,415.76
|
| Rate for Payer: Priority Health SBD |
$10,095.27
|
|
|
HC REZUM DELIVERY DEVICE
|
Facility
|
OP
|
$3,111.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.40 |
| Max. Negotiated Rate |
$2,799.90 |
| Rate for Payer: Aetna Commercial |
$2,644.35
|
| Rate for Payer: Aetna Medicare |
$1,555.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,022.15
|
| Rate for Payer: BCBS Complete |
$1,244.40
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cofinity Commercial |
$2,177.70
|
| Rate for Payer: Cofinity Commercial |
$2,675.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,177.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,488.80
|
| Rate for Payer: Healthscope Commercial |
$2,799.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,644.35
|
| Rate for Payer: PHP Commercial |
$2,644.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,022.15
|
| Rate for Payer: Priority Health SBD |
$1,959.93
|
|
|
HC REZUM DELIVERY DEVICE
|
Facility
|
IP
|
$3,111.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,959.93 |
| Max. Negotiated Rate |
$2,799.90 |
| Rate for Payer: Aetna Commercial |
$2,644.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,022.15
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cofinity Commercial |
$2,177.70
|
| Rate for Payer: Cofinity Commercial |
$2,675.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,177.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,488.80
|
| Rate for Payer: Healthscope Commercial |
$2,799.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,644.35
|
| Rate for Payer: PHP Commercial |
$2,644.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,022.15
|
| Rate for Payer: Priority Health SBD |
$1,959.93
|
|
|
HC RF ABLATION KIDNEY TUMOR
|
Facility
|
IP
|
$7,557.46
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
36100247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,761.20 |
| Max. Negotiated Rate |
$6,801.71 |
| Rate for Payer: Aetna Commercial |
$6,423.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,912.35
|
| Rate for Payer: Cash Price |
$6,045.97
|
| Rate for Payer: Cofinity Commercial |
$5,290.22
|
| Rate for Payer: Cofinity Commercial |
$6,499.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,290.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,045.97
|
| Rate for Payer: Healthscope Commercial |
$6,801.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,423.84
|
| Rate for Payer: PHP Commercial |
$6,423.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,912.35
|
| Rate for Payer: Priority Health SBD |
$4,761.20
|
|
|
HC RF ABLATION KIDNEY TUMOR
|
Facility
|
OP
|
$7,557.46
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
36100247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Commercial |
$6,423.84
|
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,912.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Cash Price |
$6,045.97
|
| Rate for Payer: Cash Price |
$6,045.97
|
| Rate for Payer: Cofinity Commercial |
$6,499.42
|
| Rate for Payer: Cofinity Commercial |
$5,290.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,290.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,045.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Healthscope Commercial |
$6,801.71
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,423.84
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Commercial |
$6,423.84
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,912.35
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Priority Health SBD |
$4,761.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,203.54
|
| Rate for Payer: VA VA |
$5,690.13
|
|
