|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON
|
Facility
|
IP
|
$29,485.58
|
|
|
Service Code
|
CPT 0913T
|
| Hospital Charge Code |
48100152
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$20,521.96 |
| Max. Negotiated Rate |
$26,537.02 |
| Rate for Payer: Aetna Commercial |
$25,062.74
|
| Rate for Payer: BCBS Trust/PPO |
$24,352.14
|
| Rate for Payer: BCN Commercial |
$24,352.14
|
| Rate for Payer: Cash Price |
$23,588.46
|
| Rate for Payer: Cofinity Commercial |
$25,357.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,588.46
|
| Rate for Payer: Healthscope Commercial |
$26,537.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,114.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,062.74
|
| Rate for Payer: Nomi Health Commercial |
$24,178.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,114.19
|
| Rate for Payer: PHP Commercial |
$25,062.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25,652.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,521.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,947.31
|
| Rate for Payer: UHC Core |
$24,620.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,114.19
|
|
|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON
|
Facility
|
OP
|
$29,485.58
|
|
|
Service Code
|
CPT 0913T
|
| Hospital Charge Code |
48100152
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,198.31 |
| Max. Negotiated Rate |
$26,537.02 |
| Rate for Payer: Aetna Commercial |
$25,062.74
|
| Rate for Payer: Aetna Medicare |
$7,666.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,214.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,214.24
|
| Rate for Payer: BCBS Complete |
$5,457.78
|
| Rate for Payer: BCBS MAPPO |
$7,371.40
|
| Rate for Payer: BCBS Trust/PPO |
$24,240.10
|
| Rate for Payer: BCN Commercial |
$24,240.10
|
| Rate for Payer: BCN Medicare Advantage |
$7,371.40
|
| Rate for Payer: Cash Price |
$23,588.46
|
| Rate for Payer: Cofinity Commercial |
$25,357.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,588.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,371.40
|
| Rate for Payer: Healthscope Commercial |
$26,537.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,114.19
|
| Rate for Payer: Mclaren Medicaid |
$5,198.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,739.96
|
| Rate for Payer: Meridian Medicaid |
$5,457.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,477.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,108.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,062.74
|
| Rate for Payer: Nomi Health Commercial |
$24,178.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,114.19
|
| Rate for Payer: PACE Senior Care Partners |
$7,002.83
|
| Rate for Payer: PACE SWMI |
$7,371.40
|
| Rate for Payer: PHP Commercial |
$25,062.74
|
| Rate for Payer: PHP Medicare Advantage |
$7,371.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,198.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25,652.45
|
| Rate for Payer: Priority Health Medicare |
$7,445.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,521.96
|
| Rate for Payer: Railroad Medicare Medicare |
$7,371.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,947.31
|
| Rate for Payer: UHC Core |
$24,620.46
|
| Rate for Payer: UHC Exchange |
$7,371.40
|
| Rate for Payer: UHC Medicaid |
$5,198.31
|
| Rate for Payer: UHC Medicare Advantage |
$7,371.40
|
| Rate for Payer: UHCCP Medicaid |
$5,198.31
|
| Rate for Payer: VA VA |
$7,371.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,114.19
|
|
|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON SEP LESION
|
Facility
|
OP
|
$14,742.79
|
|
|
Service Code
|
CPT 0914T
|
| Hospital Charge Code |
48100153
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,599.15 |
| Max. Negotiated Rate |
$13,268.51 |
| Rate for Payer: Aetna Commercial |
$12,531.37
|
| Rate for Payer: Aetna Medicare |
$3,833.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,607.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,607.12
|
| Rate for Payer: BCBS Complete |
$2,728.89
|
| Rate for Payer: BCBS MAPPO |
$3,685.70
|
| Rate for Payer: BCBS Trust/PPO |
$12,120.05
|
| Rate for Payer: BCN Commercial |
$12,120.05
|
| Rate for Payer: BCN Medicare Advantage |
$3,685.70
|
| Rate for Payer: Cash Price |
$11,794.23
|
| Rate for Payer: Cofinity Commercial |
$12,678.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,794.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,685.70
|
| Rate for Payer: Healthscope Commercial |
$13,268.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,057.09
|
| Rate for Payer: Mclaren Medicaid |
$2,599.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,869.98
|
| Rate for Payer: Meridian Medicaid |
$2,728.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,238.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,054.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,531.37
|
| Rate for Payer: Nomi Health Commercial |
$12,089.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,057.09
|
| Rate for Payer: PACE Senior Care Partners |
$3,501.41
|
| Rate for Payer: PACE SWMI |
$3,685.70
|
| Rate for Payer: PHP Commercial |
$12,531.37
|
| Rate for Payer: PHP Medicare Advantage |
$3,685.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,599.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12,826.23
|
| Rate for Payer: Priority Health Medicare |
$3,722.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,260.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3,685.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,973.66
|
| Rate for Payer: UHC Core |
$12,310.23
|
| Rate for Payer: UHC Exchange |
$3,685.70
|
| Rate for Payer: UHC Medicaid |
$2,599.15
|
| Rate for Payer: UHC Medicare Advantage |
$3,685.70
|
| Rate for Payer: UHCCP Medicaid |
$2,599.15
|
| Rate for Payer: VA VA |
$3,685.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,057.09
|
|
|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON SEP LESION
|
Facility
|
IP
|
$14,742.79
|
|
|
Service Code
|
CPT 0914T
|
| Hospital Charge Code |
48100153
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,260.98 |
| Max. Negotiated Rate |
$13,268.51 |
| Rate for Payer: Aetna Commercial |
$12,531.37
|
| Rate for Payer: BCBS Trust/PPO |
$12,176.07
|
| Rate for Payer: BCN Commercial |
$12,176.07
|
| Rate for Payer: Cash Price |
$11,794.23
|
| Rate for Payer: Cofinity Commercial |
$12,678.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,794.23
|
| Rate for Payer: Healthscope Commercial |
$13,268.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,057.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,531.37
|
| Rate for Payer: Nomi Health Commercial |
$12,089.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,057.09
|
| Rate for Payer: PHP Commercial |
$12,531.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12,826.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,260.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,973.66
|
| Rate for Payer: UHC Core |
$12,310.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,057.09
|
|
|
HC PERQ TRANSL ANGIOPLASTY W IVUS OR OCT
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C7569
|
| Hospital Charge Code |
48100149
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,692.80 |
| Max. Negotiated Rate |
$15,120.00 |
| Rate for Payer: Aetna Commercial |
$14,280.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,875.12
|
| Rate for Payer: BCN Commercial |
$13,875.12
|
| Rate for Payer: Cash Price |
$13,440.00
|
| Rate for Payer: Cofinity Commercial |
$14,448.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,440.00
|
| Rate for Payer: Healthscope Commercial |
$15,120.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,600.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,280.00
|
| Rate for Payer: Nomi Health Commercial |
$13,776.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,600.00
|
| Rate for Payer: PHP Commercial |
$14,280.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14,616.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,692.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,784.00
|
| Rate for Payer: UHC Core |
$14,028.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,600.00
|
|
|
HC PERQ TRANSL ANGIOPLASTY W IVUS OR OCT
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C7569
|
| Hospital Charge Code |
48100149
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,961.84 |
| Max. Negotiated Rate |
$15,120.00 |
| Rate for Payer: Aetna Commercial |
$14,280.00
|
| Rate for Payer: Aetna Medicare |
$4,368.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,250.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,250.00
|
| Rate for Payer: BCBS Complete |
$3,109.68
|
| Rate for Payer: BCBS MAPPO |
$4,200.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,811.28
|
| Rate for Payer: BCN Commercial |
$13,811.28
|
| Rate for Payer: BCN Medicare Advantage |
$4,200.00
|
| Rate for Payer: Cash Price |
$13,440.00
|
| Rate for Payer: Cofinity Commercial |
$14,448.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,440.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,200.00
|
| Rate for Payer: Healthscope Commercial |
$15,120.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,600.00
|
| Rate for Payer: Mclaren Medicaid |
$2,961.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,410.00
|
| Rate for Payer: Meridian Medicaid |
$3,109.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,830.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,620.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,280.00
|
| Rate for Payer: Nomi Health Commercial |
$13,776.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,600.00
|
| Rate for Payer: PACE Senior Care Partners |
$3,990.00
|
| Rate for Payer: PACE SWMI |
$4,200.00
|
| Rate for Payer: PHP Commercial |
$14,280.00
|
| Rate for Payer: PHP Medicare Advantage |
$4,200.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,961.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14,616.00
|
| Rate for Payer: Priority Health Medicare |
$4,242.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,692.80
|
| Rate for Payer: Railroad Medicare Medicare |
$4,200.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,784.00
|
| Rate for Payer: UHC Core |
$14,028.00
|
| Rate for Payer: UHC Exchange |
$4,200.00
|
| Rate for Payer: UHC Medicaid |
$2,961.84
|
| Rate for Payer: UHC Medicare Advantage |
$4,200.00
|
| Rate for Payer: UHCCP Medicaid |
$2,961.84
|
| Rate for Payer: VA VA |
$4,200.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,600.00
|
|
|
HC PERQ TRANSL ANGIOPLASTY W LITHOTRIPSY
|
Facility
|
OP
|
$28,750.00
|
|
|
Service Code
|
HCPCS C7571
|
| Hospital Charge Code |
48100150
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,068.62 |
| Max. Negotiated Rate |
$25,875.00 |
| Rate for Payer: Aetna Commercial |
$24,437.50
|
| Rate for Payer: Aetna Medicare |
$7,475.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,984.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,984.38
|
| Rate for Payer: BCBS Complete |
$5,321.62
|
| Rate for Payer: BCBS MAPPO |
$7,187.50
|
| Rate for Payer: BCBS Trust/PPO |
$23,635.38
|
| Rate for Payer: BCN Commercial |
$23,635.38
|
| Rate for Payer: BCN Medicare Advantage |
$7,187.50
|
| Rate for Payer: Cash Price |
$23,000.00
|
| Rate for Payer: Cofinity Commercial |
$24,725.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,187.50
|
| Rate for Payer: Healthscope Commercial |
$25,875.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,562.50
|
| Rate for Payer: Mclaren Medicaid |
$5,068.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,546.88
|
| Rate for Payer: Meridian Medicaid |
$5,321.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,265.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,906.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,437.50
|
| Rate for Payer: Nomi Health Commercial |
$23,575.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,562.50
|
| Rate for Payer: PACE Senior Care Partners |
$6,828.12
|
| Rate for Payer: PACE SWMI |
$7,187.50
|
| Rate for Payer: PHP Commercial |
$24,437.50
|
| Rate for Payer: PHP Medicare Advantage |
$7,187.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,068.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25,012.50
|
| Rate for Payer: Priority Health Medicare |
$7,259.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,010.00
|
| Rate for Payer: Railroad Medicare Medicare |
$7,187.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,300.00
|
| Rate for Payer: UHC Core |
$24,006.25
|
| Rate for Payer: UHC Exchange |
$7,187.50
|
| Rate for Payer: UHC Medicaid |
$5,068.62
|
| Rate for Payer: UHC Medicare Advantage |
$7,187.50
|
| Rate for Payer: UHCCP Medicaid |
$5,068.62
|
| Rate for Payer: VA VA |
$7,187.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,562.50
|
|
|
HC PERQ TRANSL ANGIOPLASTY W LITHOTRIPSY
|
Facility
|
IP
|
$28,750.00
|
|
|
Service Code
|
HCPCS C7571
|
| Hospital Charge Code |
48100150
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$20,010.00 |
| Max. Negotiated Rate |
$25,875.00 |
| Rate for Payer: Aetna Commercial |
$24,437.50
|
| Rate for Payer: BCBS Trust/PPO |
$23,744.62
|
| Rate for Payer: BCN Commercial |
$23,744.62
|
| Rate for Payer: Cash Price |
$23,000.00
|
| Rate for Payer: Cofinity Commercial |
$24,725.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,000.00
|
| Rate for Payer: Healthscope Commercial |
$25,875.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,562.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,437.50
|
| Rate for Payer: Nomi Health Commercial |
$23,575.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,562.50
|
| Rate for Payer: PHP Commercial |
$24,437.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25,012.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,010.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,300.00
|
| Rate for Payer: UHC Core |
$24,006.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,562.50
|
|
|
HC PERQ TRANSL CORONARY ATHERECT W INTRACOR STENT
|
Facility
|
IP
|
$49,300.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100145
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$34,312.80 |
| Max. Negotiated Rate |
$44,370.00 |
| Rate for Payer: Aetna Commercial |
$41,905.00
|
| Rate for Payer: BCBS Trust/PPO |
$40,716.87
|
| Rate for Payer: BCN Commercial |
$40,716.87
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Commercial |
$42,398.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Healthscope Commercial |
$44,370.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36,975.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Nomi Health Commercial |
$40,426.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: PHP Commercial |
$41,905.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42,891.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34,312.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,384.00
|
| Rate for Payer: UHC Core |
$41,165.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36,975.00
|
|
|
HC PERQ TRANSL CORONARY ATHERECT W INTRACOR STENT
|
Facility
|
OP
|
$49,300.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100145
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,691.59 |
| Max. Negotiated Rate |
$44,370.00 |
| Rate for Payer: Aetna Commercial |
$41,905.00
|
| Rate for Payer: Aetna Medicare |
$12,818.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,406.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,406.25
|
| Rate for Payer: BCBS Complete |
$9,125.43
|
| Rate for Payer: BCBS MAPPO |
$12,325.00
|
| Rate for Payer: BCBS Trust/PPO |
$40,529.53
|
| Rate for Payer: BCN Commercial |
$40,529.53
|
| Rate for Payer: BCN Medicare Advantage |
$12,325.00
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Commercial |
$42,398.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,325.00
|
| Rate for Payer: Healthscope Commercial |
$44,370.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36,975.00
|
| Rate for Payer: Mclaren Medicaid |
$8,691.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,941.25
|
| Rate for Payer: Meridian Medicaid |
$9,125.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,173.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,557.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Nomi Health Commercial |
$40,426.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: PACE Senior Care Partners |
$11,708.75
|
| Rate for Payer: PACE SWMI |
$12,325.00
|
| Rate for Payer: PHP Commercial |
$41,905.00
|
| Rate for Payer: PHP Medicare Advantage |
$12,325.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,691.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42,891.00
|
| Rate for Payer: Priority Health Medicare |
$12,448.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34,312.80
|
| Rate for Payer: Railroad Medicare Medicare |
$12,325.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,384.00
|
| Rate for Payer: UHC Core |
$41,165.50
|
| Rate for Payer: UHC Exchange |
$12,325.00
|
| Rate for Payer: UHC Medicaid |
$8,691.59
|
| Rate for Payer: UHC Medicare Advantage |
$12,325.00
|
| Rate for Payer: UHCCP Medicaid |
$8,691.59
|
| Rate for Payer: VA VA |
$12,325.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36,975.00
|
|
|
HC PERQ TRANSL INTRACOR STENT ARTERY/BRANCHES 1 LESION
|
Facility
|
OP
|
$25,200.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100143
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,442.76 |
| Max. Negotiated Rate |
$22,680.00 |
| Rate for Payer: Aetna Commercial |
$21,420.00
|
| Rate for Payer: Aetna Medicare |
$6,552.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,875.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,875.00
|
| Rate for Payer: BCBS Complete |
$4,664.52
|
| Rate for Payer: BCBS MAPPO |
$6,300.00
|
| Rate for Payer: BCBS Trust/PPO |
$20,716.92
|
| Rate for Payer: BCN Commercial |
$20,716.92
|
| Rate for Payer: BCN Medicare Advantage |
$6,300.00
|
| Rate for Payer: Cash Price |
$20,160.00
|
| Rate for Payer: Cofinity Commercial |
$21,672.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,300.00
|
| Rate for Payer: Healthscope Commercial |
$22,680.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,900.00
|
| Rate for Payer: Mclaren Medicaid |
$4,442.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,615.00
|
| Rate for Payer: Meridian Medicaid |
$4,664.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,245.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,930.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,420.00
|
| Rate for Payer: Nomi Health Commercial |
$20,664.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,900.00
|
| Rate for Payer: PACE Senior Care Partners |
$5,985.00
|
| Rate for Payer: PACE SWMI |
$6,300.00
|
| Rate for Payer: PHP Commercial |
$21,420.00
|
| Rate for Payer: PHP Medicare Advantage |
$6,300.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,442.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21,924.00
|
| Rate for Payer: Priority Health Medicare |
$6,363.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17,539.20
|
| Rate for Payer: Railroad Medicare Medicare |
$6,300.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,176.00
|
| Rate for Payer: UHC Core |
$21,042.00
|
| Rate for Payer: UHC Exchange |
$6,300.00
|
| Rate for Payer: UHC Medicaid |
$4,442.76
|
| Rate for Payer: UHC Medicare Advantage |
$6,300.00
|
| Rate for Payer: UHCCP Medicaid |
$4,442.76
|
| Rate for Payer: VA VA |
$6,300.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,900.00
|
|
|
HC PERQ TRANSL INTRACOR STENT ARTERY/BRANCHES 1 LESION
|
Facility
|
IP
|
$25,200.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
48100143
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,539.20 |
| Max. Negotiated Rate |
$22,680.00 |
| Rate for Payer: Aetna Commercial |
$21,420.00
|
| Rate for Payer: BCBS Trust/PPO |
$20,812.68
|
| Rate for Payer: BCN Commercial |
$20,812.68
|
| Rate for Payer: Cash Price |
$20,160.00
|
| Rate for Payer: Cofinity Commercial |
$21,672.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,160.00
|
| Rate for Payer: Healthscope Commercial |
$22,680.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,900.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,420.00
|
| Rate for Payer: Nomi Health Commercial |
$20,664.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,900.00
|
| Rate for Payer: PHP Commercial |
$21,420.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21,924.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17,539.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,176.00
|
| Rate for Payer: UHC Core |
$21,042.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,900.00
|
|
|
HC PERQ TRANSL INTRACOR STENTS ARTERY/BRANCHES 2+ LESIONS
|
Facility
|
OP
|
$42,600.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
48100144
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,510.38 |
| Max. Negotiated Rate |
$38,340.00 |
| Rate for Payer: Aetna Commercial |
$36,210.00
|
| Rate for Payer: Aetna Medicare |
$11,076.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,312.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,312.50
|
| Rate for Payer: BCBS Complete |
$7,885.26
|
| Rate for Payer: BCBS MAPPO |
$10,650.00
|
| Rate for Payer: BCBS Trust/PPO |
$35,021.46
|
| Rate for Payer: BCN Commercial |
$35,021.46
|
| Rate for Payer: BCN Medicare Advantage |
$10,650.00
|
| Rate for Payer: Cash Price |
$34,080.00
|
| Rate for Payer: Cofinity Commercial |
$36,636.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,080.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,650.00
|
| Rate for Payer: Healthscope Commercial |
$38,340.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,950.00
|
| Rate for Payer: Mclaren Medicaid |
$7,510.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,182.50
|
| Rate for Payer: Meridian Medicaid |
$7,885.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,247.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,715.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,210.00
|
| Rate for Payer: Nomi Health Commercial |
$34,932.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,950.00
|
| Rate for Payer: PACE Senior Care Partners |
$10,117.50
|
| Rate for Payer: PACE SWMI |
$10,650.00
|
| Rate for Payer: PHP Commercial |
$36,210.00
|
| Rate for Payer: PHP Medicare Advantage |
$10,650.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,510.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37,062.00
|
| Rate for Payer: Priority Health Medicare |
$10,756.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29,649.60
|
| Rate for Payer: Railroad Medicare Medicare |
$10,650.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,488.00
|
| Rate for Payer: UHC Core |
$35,571.00
|
| Rate for Payer: UHC Exchange |
$10,650.00
|
| Rate for Payer: UHC Medicaid |
$7,510.38
|
| Rate for Payer: UHC Medicare Advantage |
$10,650.00
|
| Rate for Payer: UHCCP Medicaid |
$7,510.38
|
| Rate for Payer: VA VA |
$10,650.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,950.00
|
|
|
HC PERQ TRANSL INTRACOR STENTS ARTERY/BRANCHES 2+ LESIONS
|
Facility
|
IP
|
$42,600.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
48100144
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$29,649.60 |
| Max. Negotiated Rate |
$38,340.00 |
| Rate for Payer: Aetna Commercial |
$36,210.00
|
| Rate for Payer: BCBS Trust/PPO |
$35,183.34
|
| Rate for Payer: BCN Commercial |
$35,183.34
|
| Rate for Payer: Cash Price |
$34,080.00
|
| Rate for Payer: Cofinity Commercial |
$36,636.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,080.00
|
| Rate for Payer: Healthscope Commercial |
$38,340.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,950.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,210.00
|
| Rate for Payer: Nomi Health Commercial |
$34,932.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,950.00
|
| Rate for Payer: PHP Commercial |
$36,210.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37,062.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29,649.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,488.00
|
| Rate for Payer: UHC Core |
$35,571.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,950.00
|
|
|
HC PERQ TRANSL REVASC AMI/PCI
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100147
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,815.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna Medicare |
$13,000.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,625.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,625.00
|
| Rate for Payer: BCBS Complete |
$9,255.00
|
| Rate for Payer: BCBS MAPPO |
$12,500.00
|
| Rate for Payer: BCBS Trust/PPO |
$41,105.00
|
| Rate for Payer: BCN Commercial |
$41,105.00
|
| Rate for Payer: BCN Medicare Advantage |
$12,500.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,500.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,500.00
|
| Rate for Payer: Mclaren Medicaid |
$8,815.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,125.00
|
| Rate for Payer: Meridian Medicaid |
$9,255.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,375.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PACE Senior Care Partners |
$11,875.00
|
| Rate for Payer: PACE SWMI |
$12,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: PHP Medicare Advantage |
$12,500.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,815.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43,500.00
|
| Rate for Payer: Priority Health Medicare |
$12,625.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34,800.00
|
| Rate for Payer: Railroad Medicare Medicare |
$12,500.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,000.00
|
| Rate for Payer: UHC Core |
$41,750.00
|
| Rate for Payer: UHC Exchange |
$12,500.00
|
| Rate for Payer: UHC Medicaid |
$8,815.00
|
| Rate for Payer: UHC Medicare Advantage |
$12,500.00
|
| Rate for Payer: UHCCP Medicaid |
$8,815.00
|
| Rate for Payer: VA VA |
$12,500.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,500.00
|
|
|
HC PERQ TRANSL REVASC AMI/PCI
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100147
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$34,800.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: BCBS Trust/PPO |
$41,295.00
|
| Rate for Payer: BCN Commercial |
$41,295.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,500.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43,500.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34,800.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,000.00
|
| Rate for Payer: UHC Core |
$41,750.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,500.00
|
|
|
HC PERQ TRANSL REVASC CABG ARTERY/BRANCHES PCI
|
Facility
|
IP
|
$49,300.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100146
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$34,312.80 |
| Max. Negotiated Rate |
$44,370.00 |
| Rate for Payer: Aetna Commercial |
$41,905.00
|
| Rate for Payer: BCBS Trust/PPO |
$40,716.87
|
| Rate for Payer: BCN Commercial |
$40,716.87
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Commercial |
$42,398.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Healthscope Commercial |
$44,370.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36,975.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Nomi Health Commercial |
$40,426.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: PHP Commercial |
$41,905.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42,891.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34,312.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,384.00
|
| Rate for Payer: UHC Core |
$41,165.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36,975.00
|
|
|
HC PERQ TRANSL REVASC CABG ARTERY/BRANCHES PCI
|
Facility
|
OP
|
$49,300.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100146
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,691.59 |
| Max. Negotiated Rate |
$44,370.00 |
| Rate for Payer: Aetna Commercial |
$41,905.00
|
| Rate for Payer: Aetna Medicare |
$12,818.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,406.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,406.25
|
| Rate for Payer: BCBS Complete |
$9,125.43
|
| Rate for Payer: BCBS MAPPO |
$12,325.00
|
| Rate for Payer: BCBS Trust/PPO |
$40,529.53
|
| Rate for Payer: BCN Commercial |
$40,529.53
|
| Rate for Payer: BCN Medicare Advantage |
$12,325.00
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Commercial |
$42,398.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,325.00
|
| Rate for Payer: Healthscope Commercial |
$44,370.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36,975.00
|
| Rate for Payer: Mclaren Medicaid |
$8,691.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,941.25
|
| Rate for Payer: Meridian Medicaid |
$9,125.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,173.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,557.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Nomi Health Commercial |
$40,426.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: PACE Senior Care Partners |
$11,708.75
|
| Rate for Payer: PACE SWMI |
$12,325.00
|
| Rate for Payer: PHP Commercial |
$41,905.00
|
| Rate for Payer: PHP Medicare Advantage |
$12,325.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,691.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42,891.00
|
| Rate for Payer: Priority Health Medicare |
$12,448.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34,312.80
|
| Rate for Payer: Railroad Medicare Medicare |
$12,325.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,384.00
|
| Rate for Payer: UHC Core |
$41,165.50
|
| Rate for Payer: UHC Exchange |
$12,325.00
|
| Rate for Payer: UHC Medicaid |
$8,691.59
|
| Rate for Payer: UHC Medicare Advantage |
$12,325.00
|
| Rate for Payer: UHCCP Medicaid |
$8,691.59
|
| Rate for Payer: VA VA |
$12,325.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36,975.00
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100148
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,815.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna Medicare |
$13,000.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,625.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,625.00
|
| Rate for Payer: BCBS Complete |
$9,255.00
|
| Rate for Payer: BCBS MAPPO |
$12,500.00
|
| Rate for Payer: BCBS Trust/PPO |
$41,105.00
|
| Rate for Payer: BCN Commercial |
$41,105.00
|
| Rate for Payer: BCN Medicare Advantage |
$12,500.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,500.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,500.00
|
| Rate for Payer: Mclaren Medicaid |
$8,815.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,125.00
|
| Rate for Payer: Meridian Medicaid |
$9,255.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,375.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PACE Senior Care Partners |
$11,875.00
|
| Rate for Payer: PACE SWMI |
$12,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: PHP Medicare Advantage |
$12,500.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,815.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43,500.00
|
| Rate for Payer: Priority Health Medicare |
$12,625.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34,800.00
|
| Rate for Payer: Railroad Medicare Medicare |
$12,500.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,000.00
|
| Rate for Payer: UHC Core |
$41,750.00
|
| Rate for Payer: UHC Exchange |
$12,500.00
|
| Rate for Payer: UHC Medicaid |
$8,815.00
|
| Rate for Payer: UHC Medicare Advantage |
$12,500.00
|
| Rate for Payer: UHCCP Medicaid |
$8,815.00
|
| Rate for Payer: VA VA |
$12,500.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,500.00
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100148
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$34,800.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: BCBS Trust/PPO |
$41,295.00
|
| Rate for Payer: BCN Commercial |
$41,295.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,500.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43,500.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34,800.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,000.00
|
| Rate for Payer: UHC Core |
$41,750.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,500.00
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE & RETROGRADE
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT 92945
|
| Hospital Charge Code |
48100151
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,815.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna Medicare |
$13,000.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,625.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,625.00
|
| Rate for Payer: BCBS Complete |
$9,255.00
|
| Rate for Payer: BCBS MAPPO |
$12,500.00
|
| Rate for Payer: BCBS Trust/PPO |
$41,105.00
|
| Rate for Payer: BCN Commercial |
$41,105.00
|
| Rate for Payer: BCN Medicare Advantage |
$12,500.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,500.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,500.00
|
| Rate for Payer: Mclaren Medicaid |
$8,815.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,125.00
|
| Rate for Payer: Meridian Medicaid |
$9,255.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,375.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PACE Senior Care Partners |
$11,875.00
|
| Rate for Payer: PACE SWMI |
$12,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: PHP Medicare Advantage |
$12,500.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,815.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43,500.00
|
| Rate for Payer: Priority Health Medicare |
$12,625.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34,800.00
|
| Rate for Payer: Railroad Medicare Medicare |
$12,500.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,000.00
|
| Rate for Payer: UHC Core |
$41,750.00
|
| Rate for Payer: UHC Exchange |
$12,500.00
|
| Rate for Payer: UHC Medicaid |
$8,815.00
|
| Rate for Payer: UHC Medicare Advantage |
$12,500.00
|
| Rate for Payer: UHCCP Medicaid |
$8,815.00
|
| Rate for Payer: VA VA |
$12,500.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,500.00
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE & RETROGRADE
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT 92945
|
| Hospital Charge Code |
48100151
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$34,800.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: BCBS Trust/PPO |
$41,295.00
|
| Rate for Payer: BCN Commercial |
$41,295.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,500.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43,500.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34,800.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,000.00
|
| Rate for Payer: UHC Core |
$41,750.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,500.00
|
|
|
HC PERQ TRANSLUM ATHERECTOMY ARTERY/BRANCHES
|
Facility
|
IP
|
$28,200.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100142
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$19,627.20 |
| Max. Negotiated Rate |
$25,380.00 |
| Rate for Payer: Aetna Commercial |
$23,970.00
|
| Rate for Payer: BCBS Trust/PPO |
$23,290.38
|
| Rate for Payer: BCN Commercial |
$23,290.38
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cofinity Commercial |
$24,252.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,560.00
|
| Rate for Payer: Healthscope Commercial |
$25,380.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,970.00
|
| Rate for Payer: Nomi Health Commercial |
$23,124.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,150.00
|
| Rate for Payer: PHP Commercial |
$23,970.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24,534.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,627.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,816.00
|
| Rate for Payer: UHC Core |
$23,547.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,150.00
|
|
|
HC PERQ TRANSLUM ATHERECTOMY ARTERY/BRANCHES
|
Facility
|
OP
|
$28,200.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100142
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,971.66 |
| Max. Negotiated Rate |
$25,380.00 |
| Rate for Payer: Aetna Commercial |
$23,970.00
|
| Rate for Payer: Aetna Medicare |
$7,332.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,812.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,812.50
|
| Rate for Payer: BCBS Complete |
$5,219.82
|
| Rate for Payer: BCBS MAPPO |
$7,050.00
|
| Rate for Payer: BCBS Trust/PPO |
$23,183.22
|
| Rate for Payer: BCN Commercial |
$23,183.22
|
| Rate for Payer: BCN Medicare Advantage |
$7,050.00
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cofinity Commercial |
$24,252.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,050.00
|
| Rate for Payer: Healthscope Commercial |
$25,380.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,150.00
|
| Rate for Payer: Mclaren Medicaid |
$4,971.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,402.50
|
| Rate for Payer: Meridian Medicaid |
$5,219.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,107.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,755.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,970.00
|
| Rate for Payer: Nomi Health Commercial |
$23,124.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,150.00
|
| Rate for Payer: PACE Senior Care Partners |
$6,697.50
|
| Rate for Payer: PACE SWMI |
$7,050.00
|
| Rate for Payer: PHP Commercial |
$23,970.00
|
| Rate for Payer: PHP Medicare Advantage |
$7,050.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,971.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24,534.00
|
| Rate for Payer: Priority Health Medicare |
$7,120.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,627.20
|
| Rate for Payer: Railroad Medicare Medicare |
$7,050.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,816.00
|
| Rate for Payer: UHC Core |
$23,547.00
|
| Rate for Payer: UHC Exchange |
$7,050.00
|
| Rate for Payer: UHC Medicaid |
$4,971.66
|
| Rate for Payer: UHC Medicare Advantage |
$7,050.00
|
| Rate for Payer: UHCCP Medicaid |
$4,971.66
|
| Rate for Payer: VA VA |
$7,050.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,150.00
|
|
|
HC PERQ TRANSLUM BALLOON ANGIO ARTERY/BRANCHES
|
Facility
|
OP
|
$18,900.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,332.07 |
| Max. Negotiated Rate |
$17,010.00 |
| Rate for Payer: Aetna Commercial |
$16,065.00
|
| Rate for Payer: Aetna Medicare |
$4,914.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,906.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,906.25
|
| Rate for Payer: BCBS Complete |
$3,498.39
|
| Rate for Payer: BCBS MAPPO |
$4,725.00
|
| Rate for Payer: BCBS Trust/PPO |
$15,537.69
|
| Rate for Payer: BCN Commercial |
$15,537.69
|
| Rate for Payer: BCN Medicare Advantage |
$4,725.00
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cofinity Commercial |
$16,254.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,725.00
|
| Rate for Payer: Healthscope Commercial |
$17,010.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,175.00
|
| Rate for Payer: Mclaren Medicaid |
$3,332.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,961.25
|
| Rate for Payer: Meridian Medicaid |
$3,498.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,433.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,197.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,065.00
|
| Rate for Payer: Nomi Health Commercial |
$15,498.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,175.00
|
| Rate for Payer: PACE Senior Care Partners |
$4,488.75
|
| Rate for Payer: PACE SWMI |
$4,725.00
|
| Rate for Payer: PHP Commercial |
$16,065.00
|
| Rate for Payer: PHP Medicare Advantage |
$4,725.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,332.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16,443.00
|
| Rate for Payer: Priority Health Medicare |
$4,772.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,154.40
|
| Rate for Payer: Railroad Medicare Medicare |
$4,725.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,632.00
|
| Rate for Payer: UHC Core |
$15,781.50
|
| Rate for Payer: UHC Exchange |
$4,725.00
|
| Rate for Payer: UHC Medicaid |
$3,332.07
|
| Rate for Payer: UHC Medicare Advantage |
$4,725.00
|
| Rate for Payer: UHCCP Medicaid |
$3,332.07
|
| Rate for Payer: VA VA |
$4,725.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,175.00
|
|
