|
HC STENT NON CORONARY LVL 3
|
Facility
|
IP
|
$501.23
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.77 |
| Max. Negotiated Rate |
$451.11 |
| Rate for Payer: Aetna Commercial |
$426.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.80
|
| Rate for Payer: Cash Price |
$400.98
|
| Rate for Payer: Cofinity Commercial |
$350.86
|
| Rate for Payer: Cofinity Commercial |
$431.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.98
|
| Rate for Payer: Healthscope Commercial |
$451.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.05
|
| Rate for Payer: PHP Commercial |
$426.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.80
|
| Rate for Payer: Priority Health SBD |
$315.77
|
|
|
HC STENT NON CORONARY LVL 3
|
Facility
|
OP
|
$501.23
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.49 |
| Max. Negotiated Rate |
$451.11 |
| Rate for Payer: Aetna Commercial |
$426.05
|
| Rate for Payer: Aetna Medicare |
$250.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.80
|
| Rate for Payer: BCBS Complete |
$200.49
|
| Rate for Payer: Cash Price |
$400.98
|
| Rate for Payer: Cofinity Commercial |
$350.86
|
| Rate for Payer: Cofinity Commercial |
$431.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.98
|
| Rate for Payer: Healthscope Commercial |
$451.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.05
|
| Rate for Payer: PHP Commercial |
$426.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.80
|
| Rate for Payer: Priority Health SBD |
$315.77
|
|
|
HC STENT NON CORONARY LVL 4
|
Facility
|
OP
|
$838.73
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27200103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.49 |
| Max. Negotiated Rate |
$754.86 |
| Rate for Payer: Aetna Commercial |
$712.92
|
| Rate for Payer: Aetna Medicare |
$419.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.17
|
| Rate for Payer: BCBS Complete |
$335.49
|
| Rate for Payer: Cash Price |
$670.98
|
| Rate for Payer: Cofinity Commercial |
$587.11
|
| Rate for Payer: Cofinity Commercial |
$721.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$587.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.98
|
| Rate for Payer: Healthscope Commercial |
$754.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.92
|
| Rate for Payer: PHP Commercial |
$712.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.17
|
| Rate for Payer: Priority Health SBD |
$528.40
|
|
|
HC STENT NON CORONARY LVL 4
|
Facility
|
IP
|
$838.73
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27200103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$528.40 |
| Max. Negotiated Rate |
$754.86 |
| Rate for Payer: Aetna Commercial |
$712.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.17
|
| Rate for Payer: Cash Price |
$670.98
|
| Rate for Payer: Cofinity Commercial |
$587.11
|
| Rate for Payer: Cofinity Commercial |
$721.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$587.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.98
|
| Rate for Payer: Healthscope Commercial |
$754.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.92
|
| Rate for Payer: PHP Commercial |
$712.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.17
|
| Rate for Payer: Priority Health SBD |
$528.40
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL
|
Facility
|
IP
|
$10,616.58
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
36100425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,688.45 |
| Max. Negotiated Rate |
$9,554.92 |
| Rate for Payer: Aetna Commercial |
$9,024.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,900.78
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$7,431.61
|
| Rate for Payer: Cofinity Commercial |
$9,130.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,431.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Healthscope Commercial |
$9,554.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: PHP Commercial |
$9,024.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: Priority Health SBD |
$6,688.45
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CER CAROTID INTRACRAN EA ADDLL
|
Facility
|
OP
|
$10,616.58
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
36100425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,246.63 |
| Max. Negotiated Rate |
$9,554.92 |
| Rate for Payer: Aetna Commercial |
$9,024.09
|
| Rate for Payer: Aetna Medicare |
$5,308.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,900.78
|
| Rate for Payer: BCBS Complete |
$4,246.63
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$7,431.61
|
| Rate for Payer: Cofinity Commercial |
$9,130.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,431.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Healthscope Commercial |
$9,554.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: PHP Commercial |
$9,024.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: Priority Health SBD |
$6,688.45
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CERV CAROTID INTRACRAN
|
Facility
|
IP
|
$16,403.51
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
36100424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,334.21 |
| Max. Negotiated Rate |
$14,763.16 |
| Rate for Payer: Aetna Commercial |
$13,942.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,662.28
|
| Rate for Payer: Cash Price |
$13,122.81
|
| Rate for Payer: Cofinity Commercial |
$11,482.46
|
| Rate for Payer: Cofinity Commercial |
$14,107.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,482.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,122.81
|
| Rate for Payer: Healthscope Commercial |
$14,763.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,942.98
|
| Rate for Payer: PHP Commercial |
$13,942.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,662.28
|
| Rate for Payer: Priority Health SBD |
$10,334.21
|
|
|
HC STENT PLACE OTHER THAN LOWER EXTREM CERV CAROTID INTRACRAN
|
Facility
|
OP
|
$16,403.51
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
36100424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$13,942.98
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,662.28
|
| 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 |
$13,122.81
|
| Rate for Payer: Cash Price |
$13,122.81
|
| Rate for Payer: Cofinity Commercial |
$14,107.02
|
| Rate for Payer: Cofinity Commercial |
$11,482.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,482.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,122.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$14,763.16
|
| 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 |
$13,942.98
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$13,942.98
|
| 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 |
$10,662.28
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$10,334.21
|
| 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 STENT PLACE VENOUS
|
Facility
|
OP
|
$18,746.85
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
36100426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$15,934.82
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,185.45
|
| 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 |
$14,997.48
|
| Rate for Payer: Cash Price |
$14,997.48
|
| Rate for Payer: Cofinity Commercial |
$13,122.80
|
| Rate for Payer: Cofinity Commercial |
$16,122.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,122.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,997.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$16,872.17
|
| 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 |
$15,934.82
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$15,934.82
|
| 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 |
$12,185.45
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$11,810.52
|
| 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 STENT PLACE VENOUS
|
Facility
|
IP
|
$18,746.85
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
36100426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,810.52 |
| Max. Negotiated Rate |
$16,872.17 |
| Rate for Payer: Aetna Commercial |
$15,934.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,185.45
|
| Rate for Payer: Cash Price |
$14,997.48
|
| Rate for Payer: Cofinity Commercial |
$13,122.80
|
| Rate for Payer: Cofinity Commercial |
$16,122.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,122.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,997.48
|
| Rate for Payer: Healthscope Commercial |
$16,872.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,934.82
|
| Rate for Payer: PHP Commercial |
$15,934.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,185.45
|
| Rate for Payer: Priority Health SBD |
$11,810.52
|
|
|
HC STENT PLACE VENOUS EA ADDL VEIN
|
Facility
|
IP
|
$10,616.58
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,688.45 |
| Max. Negotiated Rate |
$9,554.92 |
| Rate for Payer: Aetna Commercial |
$9,024.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,900.78
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$7,431.61
|
| Rate for Payer: Cofinity Commercial |
$9,130.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,431.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Healthscope Commercial |
$9,554.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: PHP Commercial |
$9,024.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: Priority Health SBD |
$6,688.45
|
|
|
HC STENT PLACE VENOUS EA ADDL VEIN
|
Facility
|
OP
|
$10,616.58
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,246.63 |
| Max. Negotiated Rate |
$9,554.92 |
| Rate for Payer: Aetna Commercial |
$9,024.09
|
| Rate for Payer: Aetna Medicare |
$5,308.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,900.78
|
| Rate for Payer: BCBS Complete |
$4,246.63
|
| Rate for Payer: Cash Price |
$8,493.26
|
| Rate for Payer: Cofinity Commercial |
$7,431.61
|
| Rate for Payer: Cofinity Commercial |
$9,130.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,431.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,493.26
|
| Rate for Payer: Healthscope Commercial |
$9,554.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.09
|
| Rate for Payer: PHP Commercial |
$9,024.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,900.78
|
| Rate for Payer: Priority Health SBD |
$6,688.45
|
|
|
HC STENT TRASCATH VEIN EACH ADDL
|
Facility
|
OP
|
$6,855.32
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,742.13 |
| Max. Negotiated Rate |
$6,169.79 |
| Rate for Payer: Aetna Commercial |
$5,827.02
|
| Rate for Payer: Aetna Medicare |
$3,427.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,455.96
|
| Rate for Payer: BCBS Complete |
$2,742.13
|
| Rate for Payer: Cash Price |
$5,484.26
|
| Rate for Payer: Cofinity Commercial |
$4,798.72
|
| Rate for Payer: Cofinity Commercial |
$5,895.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,798.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,484.26
|
| Rate for Payer: Healthscope Commercial |
$6,169.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,827.02
|
| Rate for Payer: PHP Commercial |
$5,827.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,455.96
|
| Rate for Payer: Priority Health SBD |
$4,318.85
|
|
|
HC STENT TRASCATH VEIN EACH ADDL
|
Facility
|
IP
|
$6,855.32
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
36100441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,318.85 |
| Max. Negotiated Rate |
$6,169.79 |
| Rate for Payer: Aetna Commercial |
$5,827.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,455.96
|
| Rate for Payer: Cash Price |
$5,484.26
|
| Rate for Payer: Cofinity Commercial |
$4,798.72
|
| Rate for Payer: Cofinity Commercial |
$5,895.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,798.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,484.26
|
| Rate for Payer: Healthscope Commercial |
$6,169.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,827.02
|
| Rate for Payer: PHP Commercial |
$5,827.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,455.96
|
| Rate for Payer: Priority Health SBD |
$4,318.85
|
|
|
HC STENT VESSEL/BRANCH
|
Facility
|
IP
|
$24,667.58
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$15,540.58 |
| Max. Negotiated Rate |
$22,200.82 |
| Rate for Payer: Aetna Commercial |
$20,967.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,033.93
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cofinity Commercial |
$17,267.31
|
| Rate for Payer: Cofinity Commercial |
$21,214.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,267.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,734.06
|
| Rate for Payer: Healthscope Commercial |
$22,200.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,967.44
|
| Rate for Payer: PHP Commercial |
$20,967.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,033.93
|
| Rate for Payer: Priority Health SBD |
$15,540.58
|
|
|
HC STENT VESSEL/BRANCH
|
Facility
|
OP
|
$24,667.58
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$20,967.44
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,033.93
|
| 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 |
$19,734.06
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cofinity Commercial |
$17,267.31
|
| Rate for Payer: Cofinity Commercial |
$21,214.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,267.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,734.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$22,200.82
|
| 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 |
$20,967.44
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$20,967.44
|
| 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 |
$16,033.93
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$15,540.58
|
| 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 ST JUDE CRT ICD
|
Facility
|
OP
|
$28,090.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500009
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,236.32 |
| Max. Negotiated Rate |
$25,281.72 |
| Rate for Payer: Aetna Commercial |
$23,877.18
|
| Rate for Payer: Aetna Medicare |
$14,045.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,259.02
|
| Rate for Payer: BCBS Complete |
$11,236.32
|
| Rate for Payer: Cash Price |
$22,472.64
|
| Rate for Payer: Cofinity Commercial |
$19,663.56
|
| Rate for Payer: Cofinity Commercial |
$24,158.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$19,663.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,472.64
|
| Rate for Payer: Healthscope Commercial |
$25,281.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,877.18
|
| Rate for Payer: PHP Commercial |
$23,877.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,259.02
|
| Rate for Payer: Priority Health SBD |
$17,697.20
|
|
|
HC ST JUDE CRT ICD
|
Facility
|
IP
|
$28,090.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500009
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$17,697.20 |
| Max. Negotiated Rate |
$25,281.72 |
| Rate for Payer: Aetna Commercial |
$23,877.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,259.02
|
| Rate for Payer: Cash Price |
$22,472.64
|
| Rate for Payer: Cofinity Commercial |
$19,663.56
|
| Rate for Payer: Cofinity Commercial |
$24,158.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$19,663.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,472.64
|
| Rate for Payer: Healthscope Commercial |
$25,281.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,877.18
|
| Rate for Payer: PHP Commercial |
$23,877.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,259.02
|
| Rate for Payer: Priority Health SBD |
$17,697.20
|
|
|
HC ST JUDE CRT LEAD
|
Facility
|
IP
|
$5,826.24
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,670.53 |
| Max. Negotiated Rate |
$5,243.62 |
| Rate for Payer: Aetna Commercial |
$4,952.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,787.06
|
| Rate for Payer: Cash Price |
$4,660.99
|
| Rate for Payer: Cofinity Commercial |
$4,078.37
|
| Rate for Payer: Cofinity Commercial |
$5,010.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,078.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,660.99
|
| Rate for Payer: Healthscope Commercial |
$5,243.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,952.30
|
| Rate for Payer: PHP Commercial |
$4,952.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,787.06
|
| Rate for Payer: Priority Health SBD |
$3,670.53
|
|
|
HC ST JUDE CRT LEAD
|
Facility
|
OP
|
$5,826.24
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,330.50 |
| Max. Negotiated Rate |
$5,243.62 |
| Rate for Payer: Aetna Commercial |
$4,952.30
|
| Rate for Payer: Aetna Medicare |
$2,913.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,787.06
|
| Rate for Payer: BCBS Complete |
$2,330.50
|
| Rate for Payer: Cash Price |
$4,660.99
|
| Rate for Payer: Cofinity Commercial |
$4,078.37
|
| Rate for Payer: Cofinity Commercial |
$5,010.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,078.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,660.99
|
| Rate for Payer: Healthscope Commercial |
$5,243.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,952.30
|
| Rate for Payer: PHP Commercial |
$4,952.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,787.06
|
| Rate for Payer: Priority Health SBD |
$3,670.53
|
|
|
HC ST JUDE DUAL PACEMAKER
|
Facility
|
IP
|
$9,363.60
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500010
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,899.07 |
| Max. Negotiated Rate |
$8,427.24 |
| Rate for Payer: Aetna Commercial |
$7,959.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,086.34
|
| Rate for Payer: Cash Price |
$7,490.88
|
| Rate for Payer: Cofinity Commercial |
$6,554.52
|
| Rate for Payer: Cofinity Commercial |
$8,052.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,554.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,490.88
|
| Rate for Payer: Healthscope Commercial |
$8,427.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,959.06
|
| Rate for Payer: PHP Commercial |
$7,959.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,086.34
|
| Rate for Payer: Priority Health SBD |
$5,899.07
|
|
|
HC ST JUDE DUAL PACEMAKER
|
Facility
|
OP
|
$9,363.60
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500010
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,745.44 |
| Max. Negotiated Rate |
$8,427.24 |
| Rate for Payer: Aetna Commercial |
$7,959.06
|
| Rate for Payer: Aetna Medicare |
$4,681.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,086.34
|
| Rate for Payer: BCBS Complete |
$3,745.44
|
| Rate for Payer: Cash Price |
$7,490.88
|
| Rate for Payer: Cofinity Commercial |
$6,554.52
|
| Rate for Payer: Cofinity Commercial |
$8,052.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,554.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,490.88
|
| Rate for Payer: Healthscope Commercial |
$8,427.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,959.06
|
| Rate for Payer: PHP Commercial |
$7,959.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,086.34
|
| Rate for Payer: Priority Health SBD |
$5,899.07
|
|
|
HC ST JUDE ICD DUAL
|
Facility
|
IP
|
$21,224.16
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,371.22 |
| Max. Negotiated Rate |
$19,101.74 |
| Rate for Payer: Aetna Commercial |
$18,040.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,795.70
|
| Rate for Payer: Cash Price |
$16,979.33
|
| Rate for Payer: Cofinity Commercial |
$14,856.91
|
| Rate for Payer: Cofinity Commercial |
$18,252.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,856.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,979.33
|
| Rate for Payer: Healthscope Commercial |
$19,101.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,040.54
|
| Rate for Payer: PHP Commercial |
$18,040.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,795.70
|
| Rate for Payer: Priority Health SBD |
$13,371.22
|
|
|
HC ST JUDE ICD DUAL
|
Facility
|
OP
|
$21,224.16
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,489.66 |
| Max. Negotiated Rate |
$19,101.74 |
| Rate for Payer: Aetna Commercial |
$18,040.54
|
| Rate for Payer: Aetna Medicare |
$10,612.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,795.70
|
| Rate for Payer: BCBS Complete |
$8,489.66
|
| Rate for Payer: Cash Price |
$16,979.33
|
| Rate for Payer: Cofinity Commercial |
$14,856.91
|
| Rate for Payer: Cofinity Commercial |
$18,252.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,856.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,979.33
|
| Rate for Payer: Healthscope Commercial |
$19,101.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,040.54
|
| Rate for Payer: PHP Commercial |
$18,040.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,795.70
|
| Rate for Payer: Priority Health SBD |
$13,371.22
|
|
|
HC ST JUDE ICD SINGLE
|
Facility
|
OP
|
$14,066.21
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,626.48 |
| Max. Negotiated Rate |
$12,659.59 |
| Rate for Payer: Aetna Commercial |
$11,956.28
|
| Rate for Payer: Aetna Medicare |
$7,033.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,143.04
|
| Rate for Payer: BCBS Complete |
$5,626.48
|
| Rate for Payer: Cash Price |
$11,252.97
|
| Rate for Payer: Cofinity Commercial |
$12,096.94
|
| Rate for Payer: Cofinity Commercial |
$9,846.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,846.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,252.97
|
| Rate for Payer: Healthscope Commercial |
$12,659.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,956.28
|
| Rate for Payer: PHP Commercial |
$11,956.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,143.04
|
| Rate for Payer: Priority Health SBD |
$8,861.71
|
|
