Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$17,228.25

Service Code	MSDRG 204
Min. Negotiated Rate	$6,977.76
Max. Negotiated Rate	$17,228.25
Rate for Payer: Aetna Medicare	$7,638.81
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,181.26
Rate for Payer: Amish Plain Church Group Commercial	$9,181.26
Rate for Payer: BCBS MAPPO	$7,345.01
Rate for Payer: BCBS Trust/PPO	$17,228.25
Rate for Payer: BCN Commercial	$17,228.25
Rate for Payer: BCN Medicare Advantage	$7,345.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,345.01
Rate for Payer: Mclaren Medicare	$7,345.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,712.26
Rate for Payer: MI Amish Medical Board Commercial	$8,446.76
Rate for Payer: Molina Medicare/Medicaid	$8,079.51
Rate for Payer: Nomi Health Commercial	$10,415.46
Rate for Payer: PACE Medicare	$6,977.76
Rate for Payer: PACE SWMI	$7,345.01
Rate for Payer: PHP Medicare Advantage	$7,345.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$13,017.02
Rate for Payer: Priority Health Medicare	$7,345.01
Rate for Payer: Priority Health Tiered Network	$10,413.61
Rate for Payer: Railroad Medicare Medicare	$7,345.01
Rate for Payer: UHC All Payor (Choice/PPO)	$13,160.62
Rate for Payer: UHC Core	$11,010.51
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,345.01
Rate for Payer: UHC Exchange	$8,992.01
Rate for Payer: VA VA	$7,345.01

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$3,194.91

Service Code	APR-DRG 1441
Min. Negotiated Rate	$3,042.77
Max. Negotiated Rate	$3,194.91
Rate for Payer: BCBS Complete	$3,194.91
Rate for Payer: Mclaren Medicaid	$3,042.77
Rate for Payer: Meridian Medicaid	$3,194.91
Rate for Payer: Priority Health Choice Medicaid	$3,042.77
Rate for Payer: UHC Medicaid	$3,042.77
Rate for Payer: UHCCP Medicaid	$3,042.77

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$7,555.67

Service Code	APR-DRG 1443
Min. Negotiated Rate	$7,195.87
Max. Negotiated Rate	$7,555.67
Rate for Payer: BCBS Complete	$7,555.67
Rate for Payer: Mclaren Medicaid	$7,195.87
Rate for Payer: Meridian Medicaid	$7,555.67
Rate for Payer: Priority Health Choice Medicaid	$7,195.87
Rate for Payer: UHC Medicaid	$7,195.87
Rate for Payer: UHCCP Medicaid	$7,195.87

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$11,897.06

Service Code	APR-DRG 1444
Min. Negotiated Rate	$11,330.53
Max. Negotiated Rate	$11,897.06
Rate for Payer: BCBS Complete	$11,897.06
Rate for Payer: Mclaren Medicaid	$11,330.53
Rate for Payer: Meridian Medicaid	$11,897.06
Rate for Payer: Priority Health Choice Medicaid	$11,330.53
Rate for Payer: UHC Medicaid	$11,330.53
Rate for Payer: UHCCP Medicaid	$11,330.53

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$5,685.21

Service Code	APR-DRG 1442
Min. Negotiated Rate	$5,414.49
Max. Negotiated Rate	$5,685.21
Rate for Payer: BCBS Complete	$5,685.21
Rate for Payer: Mclaren Medicaid	$5,414.49
Rate for Payer: Meridian Medicaid	$5,685.21
Rate for Payer: Priority Health Choice Medicaid	$5,414.49
Rate for Payer: UHC Medicaid	$5,414.49
Rate for Payer: UHCCP Medicaid	$5,414.49

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$48,654.15

Service Code	MSDRG 208
Min. Negotiated Rate	$22,400.52
Max. Negotiated Rate	$48,654.15
Rate for Payer: Aetna Medicare	$24,522.67
Rate for Payer: Allen County Amish Medical Aid Commercial	$29,474.36
Rate for Payer: Amish Plain Church Group Commercial	$29,474.36
Rate for Payer: BCBS MAPPO	$23,579.49
Rate for Payer: BCBS Trust/PPO	$48,654.15
Rate for Payer: BCN Commercial	$48,654.15
Rate for Payer: BCN Medicare Advantage	$23,579.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$23,579.49
Rate for Payer: Mclaren Medicare	$23,579.49
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$24,758.46
Rate for Payer: MI Amish Medical Board Commercial	$27,116.41
Rate for Payer: Molina Medicare/Medicaid	$25,937.44
Rate for Payer: Nomi Health Commercial	$35,458.23
Rate for Payer: PACE Medicare	$22,400.52
Rate for Payer: PACE SWMI	$23,579.49
Rate for Payer: PHP Medicare Advantage	$23,579.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$44,314.93
Rate for Payer: Priority Health Medicare	$23,579.49
Rate for Payer: Priority Health Tiered Network	$35,451.94
Rate for Payer: Railroad Medicare Medicare	$23,579.49
Rate for Payer: UHC All Payor (Choice/PPO)	$44,803.81
Rate for Payer: UHC Core	$37,484.02
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$23,579.49
Rate for Payer: UHC Exchange	$30,612.27
Rate for Payer: VA VA	$23,579.49

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$29,311.65

Service Code	APR-DRG 1304
Min. Negotiated Rate	$27,915.86
Max. Negotiated Rate	$29,311.65
Rate for Payer: BCBS Complete	$29,311.65
Rate for Payer: Mclaren Medicaid	$27,915.86
Rate for Payer: Meridian Medicaid	$29,311.65
Rate for Payer: Priority Health Choice Medicaid	$27,915.86
Rate for Payer: UHC Medicaid	$27,915.86
Rate for Payer: UHCCP Medicaid	$27,915.86

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$26,254.16

Service Code	APR-DRG 1303
Min. Negotiated Rate	$25,003.96
Max. Negotiated Rate	$26,254.16
Rate for Payer: BCBS Complete	$26,254.16
Rate for Payer: Mclaren Medicaid	$25,003.96
Rate for Payer: Meridian Medicaid	$26,254.16
Rate for Payer: Priority Health Choice Medicaid	$25,003.96
Rate for Payer: UHC Medicaid	$25,003.96
Rate for Payer: UHCCP Medicaid	$25,003.96

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$15,220.90

Service Code	APR-DRG 1301
Min. Negotiated Rate	$14,496.09
Max. Negotiated Rate	$15,220.90
Rate for Payer: BCBS Complete	$15,220.90
Rate for Payer: Mclaren Medicaid	$14,496.09
Rate for Payer: Meridian Medicaid	$15,220.90
Rate for Payer: Priority Health Choice Medicaid	$14,496.09
Rate for Payer: UHC Medicaid	$14,496.09
Rate for Payer: UHCCP Medicaid	$14,496.09

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$19,368.58

Service Code	APR-DRG 1302
Min. Negotiated Rate	$18,446.27
Max. Negotiated Rate	$19,368.58
Rate for Payer: BCBS Complete	$19,368.58
Rate for Payer: Mclaren Medicaid	$18,446.27
Rate for Payer: Meridian Medicaid	$19,368.58
Rate for Payer: Priority Health Choice Medicaid	$18,446.27
Rate for Payer: UHC Medicaid	$18,446.27
Rate for Payer: UHCCP Medicaid	$18,446.27

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$151,430.70

Service Code	MSDRG 207
Min. Negotiated Rate	$51,684.20
Max. Negotiated Rate	$151,430.70
Rate for Payer: Aetna Medicare	$56,580.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$68,005.52
Rate for Payer: Amish Plain Church Group Commercial	$68,005.52
Rate for Payer: BCBS MAPPO	$54,404.42
Rate for Payer: BCBS Trust/PPO	$151,430.70
Rate for Payer: BCN Commercial	$151,430.70
Rate for Payer: BCN Medicare Advantage	$54,404.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$54,404.42
Rate for Payer: Mclaren Medicare	$54,404.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$57,124.64
Rate for Payer: MI Amish Medical Board Commercial	$62,565.08
Rate for Payer: Molina Medicare/Medicaid	$59,844.86
Rate for Payer: Nomi Health Commercial	$83,007.63
Rate for Payer: PACE Medicare	$51,684.20
Rate for Payer: PACE SWMI	$54,404.42
Rate for Payer: PHP Medicare Advantage	$54,404.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$103,741.13
Rate for Payer: Priority Health Medicare	$54,404.42
Rate for Payer: Priority Health Tiered Network	$82,992.89
Rate for Payer: Railroad Medicare Medicare	$54,404.42
Rate for Payer: UHC All Payor (Choice/PPO)	$104,885.61
Rate for Payer: UHC Core	$87,750.00
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$54,404.42
Rate for Payer: UHC Exchange	$71,663.25
Rate for Payer: VA VA	$54,404.42

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility

$18,751.78

Service Code	MSDRG 815
Min. Negotiated Rate	$8,619.10
Max. Negotiated Rate	$18,751.78
Rate for Payer: Aetna Medicare	$9,435.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,340.92
Rate for Payer: Amish Plain Church Group Commercial	$11,340.92
Rate for Payer: BCBS MAPPO	$9,072.74
Rate for Payer: BCBS Trust/PPO	$18,751.78
Rate for Payer: BCN Commercial	$18,751.78
Rate for Payer: BCN Medicare Advantage	$9,072.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,072.74
Rate for Payer: Mclaren Medicare	$9,072.74
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,526.38
Rate for Payer: MI Amish Medical Board Commercial	$10,433.65
Rate for Payer: Molina Medicare/Medicaid	$9,980.01
Rate for Payer: Nomi Health Commercial	$13,080.60
Rate for Payer: PACE Medicare	$8,619.10
Rate for Payer: PACE SWMI	$9,072.74
Rate for Payer: PHP Medicare Advantage	$9,072.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$16,347.85
Rate for Payer: Priority Health Medicare	$9,072.74
Rate for Payer: Priority Health Tiered Network	$13,078.28
Rate for Payer: Railroad Medicare Medicare	$9,072.74
Rate for Payer: UHC All Payor (Choice/PPO)	$16,528.20
Rate for Payer: UHC Core	$13,827.92
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,072.74
Rate for Payer: UHC Exchange	$11,292.92
Rate for Payer: VA VA	$9,072.74

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility

$45,887.09

Service Code	MSDRG 814
Min. Negotiated Rate	$17,459.01
Max. Negotiated Rate	$45,887.09
Rate for Payer: Aetna Medicare	$19,113.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,972.39
Rate for Payer: Amish Plain Church Group Commercial	$22,972.39
Rate for Payer: BCBS MAPPO	$18,377.91
Rate for Payer: BCBS Trust/PPO	$45,887.09
Rate for Payer: BCN Commercial	$45,887.09
Rate for Payer: BCN Medicare Advantage	$18,377.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,377.91
Rate for Payer: Mclaren Medicare	$18,377.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19,296.81
Rate for Payer: MI Amish Medical Board Commercial	$21,134.60
Rate for Payer: Molina Medicare/Medicaid	$20,215.70
Rate for Payer: Nomi Health Commercial	$27,434.43
Rate for Payer: PACE Medicare	$17,459.01
Rate for Payer: PACE SWMI	$18,377.91
Rate for Payer: PHP Medicare Advantage	$18,377.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,286.96
Rate for Payer: Priority Health Medicare	$18,377.91
Rate for Payer: Priority Health Tiered Network	$27,429.56
Rate for Payer: Railroad Medicare Medicare	$18,377.91
Rate for Payer: UHC All Payor (Choice/PPO)	$34,665.21
Rate for Payer: UHC Core	$29,001.81
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18,377.91
Rate for Payer: UHC Exchange	$23,685.06
Rate for Payer: VA VA	$18,377.91

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility

$13,404.32

Service Code	MSDRG 816
Min. Negotiated Rate	$5,584.27
Max. Negotiated Rate	$13,404.32
Rate for Payer: Aetna Medicare	$6,113.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,347.73
Rate for Payer: Amish Plain Church Group Commercial	$7,347.73
Rate for Payer: BCBS MAPPO	$5,878.18
Rate for Payer: BCBS Trust/PPO	$13,404.32
Rate for Payer: BCN Commercial	$13,404.32
Rate for Payer: BCN Medicare Advantage	$5,878.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,878.18
Rate for Payer: Mclaren Medicare	$5,878.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,172.09
Rate for Payer: MI Amish Medical Board Commercial	$6,759.91
Rate for Payer: Molina Medicare/Medicaid	$6,466.00
Rate for Payer: Nomi Health Commercial	$8,152.80
Rate for Payer: PACE Medicare	$5,584.27
Rate for Payer: PACE SWMI	$5,878.18
Rate for Payer: PHP Medicare Advantage	$5,878.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,189.19
Rate for Payer: Priority Health Medicare	$5,878.18
Rate for Payer: Priority Health Tiered Network	$8,151.35
Rate for Payer: Railroad Medicare Medicare	$5,878.18
Rate for Payer: UHC All Payor (Choice/PPO)	$10,301.60
Rate for Payer: UHC Core	$8,618.58
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,878.18
Rate for Payer: UHC Exchange	$7,038.58
Rate for Payer: VA VA	$5,878.18

RETRIEVAL (REMOVAL) OF INTRAVASCULAR VENA CAVA FILTER, ENDOVASCULAR APPROACH INCLUDING VASCULAR ACCESS, VESSEL SELECTION, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE (ULTRASOUND AND FLUOROSCOPY), WHEN PERFORMED

Facility

$10,174.29

Service Code	CPT 37193
Hospital Revenue Code	360
Min. Negotiated Rate	$1,645.43
Max. Negotiated Rate	$10,174.29
Rate for Payer: Aetna Medicare	$3,271.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,932.66
Rate for Payer: Amish Plain Church Group Commercial	$3,932.66
Rate for Payer: BCBS Complete	$1,727.85
Rate for Payer: BCBS MAPPO	$3,146.13
Rate for Payer: BCBS Trust/PPO	$3,556.75
Rate for Payer: BCN Commercial	$3,556.75
Rate for Payer: BCN Medicare Advantage	$3,146.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,146.13
Rate for Payer: Mclaren Medicaid	$3,146.13
Rate for Payer: Mclaren Medicare	$3,146.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,303.44
Rate for Payer: Meridian Medicaid	$3,303.44
Rate for Payer: MI Amish Medical Board Commercial	$3,618.05
Rate for Payer: Molina Medicare/Medicaid	$3,460.74
Rate for Payer: Nomi Health Commercial	$9,438.39
Rate for Payer: PACE Medicare	$2,988.82
Rate for Payer: PACE SWMI	$3,146.13
Rate for Payer: PHP Medicare Advantage	$3,146.13
Rate for Payer: Priority Health Choice Medicaid	$1,645.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,174.29
Rate for Payer: Priority Health Medicare	$3,146.13
Rate for Payer: Priority Health Tiered Network	$8,139.43
Rate for Payer: Railroad Medicare Medicare	$3,146.13
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,146.13
Rate for Payer: UHC Medicaid	$1,645.43
Rate for Payer: UHCCP Medicaid	$1,645.43
Rate for Payer: VA VA	$3,146.13

REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL AND POPLITEAL VASCULAR TERRITORY, WITH TRANSLUMINAL ANGIOPLASTY, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME ARTERY, UNILATERAL; COMPLEX LESION, INITIAL VESSEL

Facility

$18,339.80

Service Code	CPT 37265
Hospital Revenue Code	360
Min. Negotiated Rate	$2,965.99
Max. Negotiated Rate	$18,339.80
Rate for Payer: Aetna Medicare	$5,897.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,088.88
Rate for Payer: Amish Plain Church Group Commercial	$7,088.88
Rate for Payer: BCBS Complete	$3,114.57
Rate for Payer: BCBS MAPPO	$5,671.10
Rate for Payer: BCN Medicare Advantage	$5,671.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,671.10
Rate for Payer: Mclaren Medicaid	$5,671.10
Rate for Payer: Mclaren Medicare	$5,671.10
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,954.65
Rate for Payer: Meridian Medicaid	$5,954.65
Rate for Payer: MI Amish Medical Board Commercial	$6,521.77
Rate for Payer: Molina Medicare/Medicaid	$6,238.21
Rate for Payer: Nomi Health Commercial	$17,013.30
Rate for Payer: PACE Medicare	$5,387.55
Rate for Payer: PACE SWMI	$5,671.10
Rate for Payer: PHP Medicare Advantage	$5,671.10
Rate for Payer: Priority Health Choice Medicaid	$2,965.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$18,339.80
Rate for Payer: Priority Health Medicare	$5,671.10
Rate for Payer: Priority Health Tiered Network	$14,671.84
Rate for Payer: Railroad Medicare Medicare	$5,671.10
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,671.10
Rate for Payer: UHC Medicaid	$2,965.99
Rate for Payer: UHCCP Medicaid	$2,965.99
Rate for Payer: VA VA	$5,671.10

Facility

$18,339.80

Service Code	CPT 37263
Hospital Revenue Code	360
Min. Negotiated Rate	$2,965.99
Max. Negotiated Rate	$18,339.80
Rate for Payer: Aetna Medicare	$5,897.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,088.88
Rate for Payer: Amish Plain Church Group Commercial	$7,088.88
Rate for Payer: BCBS Complete	$3,114.57
Rate for Payer: BCBS MAPPO	$5,671.10
Rate for Payer: BCN Medicare Advantage	$5,671.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,671.10
Rate for Payer: Mclaren Medicaid	$5,671.10
Rate for Payer: Mclaren Medicare	$5,671.10
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,954.65
Rate for Payer: Meridian Medicaid	$5,954.65
Rate for Payer: MI Amish Medical Board Commercial	$6,521.77
Rate for Payer: Molina Medicare/Medicaid	$6,238.21
Rate for Payer: Nomi Health Commercial	$17,013.30
Rate for Payer: PACE Medicare	$5,387.55
Rate for Payer: PACE SWMI	$5,671.10
Rate for Payer: PHP Medicare Advantage	$5,671.10
Rate for Payer: Priority Health Choice Medicaid	$2,965.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$18,339.80
Rate for Payer: Priority Health Medicare	$5,671.10
Rate for Payer: Priority Health Tiered Network	$14,671.84
Rate for Payer: Railroad Medicare Medicare	$5,671.10
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,671.10
Rate for Payer: UHC Medicaid	$2,965.99
Rate for Payer: UHCCP Medicaid	$2,965.99
Rate for Payer: VA VA	$5,671.10

REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL AND POPLITEAL VASCULAR TERRITORY, WITH TRANSLUMINAL ATHERECTOMY, INCLUDING TRANSLUMINAL ANGIOPLASTY WHEN PERFORMED, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ATHERECTOMY AND ANGIOPLASTY WHEN PERFORMED, WITHIN THE SAME ARTERY, UNILATERAL; COMPLEX LESION, INITIAL VESSEL

Facility

$59,069.70

Service Code	CPT 37273
Hospital Revenue Code	360
Min. Negotiated Rate	$9,552.97
Max. Negotiated Rate	$59,069.70
Rate for Payer: Aetna Medicare	$18,996.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,832.15
Rate for Payer: Amish Plain Church Group Commercial	$22,832.15
Rate for Payer: BCBS Complete	$10,031.53
Rate for Payer: BCBS MAPPO	$18,265.72
Rate for Payer: BCN Medicare Advantage	$18,265.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,265.72
Rate for Payer: Mclaren Medicaid	$18,265.72
Rate for Payer: Mclaren Medicare	$18,265.72
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19,179.01
Rate for Payer: Meridian Medicaid	$19,179.01
Rate for Payer: MI Amish Medical Board Commercial	$21,005.58
Rate for Payer: Molina Medicare/Medicaid	$20,092.29
Rate for Payer: Nomi Health Commercial	$54,797.16
Rate for Payer: PACE Medicare	$17,352.43
Rate for Payer: PACE SWMI	$18,265.72
Rate for Payer: PHP Medicare Advantage	$18,265.72
Rate for Payer: Priority Health Choice Medicaid	$9,552.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$59,069.70
Rate for Payer: Priority Health Medicare	$18,265.72
Rate for Payer: Priority Health Tiered Network	$47,255.76
Rate for Payer: Railroad Medicare Medicare	$18,265.72
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18,265.72
Rate for Payer: UHC Medicaid	$9,552.97
Rate for Payer: UHCCP Medicaid	$9,552.97
Rate for Payer: VA VA	$18,265.72

Facility

$59,069.70

Service Code	CPT 37271
Hospital Revenue Code	360
Min. Negotiated Rate	$9,552.97
Max. Negotiated Rate	$59,069.70
Rate for Payer: Aetna Medicare	$18,996.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,832.15
Rate for Payer: Amish Plain Church Group Commercial	$22,832.15
Rate for Payer: BCBS Complete	$10,031.53
Rate for Payer: BCBS MAPPO	$18,265.72
Rate for Payer: BCN Medicare Advantage	$18,265.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,265.72
Rate for Payer: Mclaren Medicaid	$18,265.72
Rate for Payer: Mclaren Medicare	$18,265.72
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19,179.01
Rate for Payer: Meridian Medicaid	$19,179.01
Rate for Payer: MI Amish Medical Board Commercial	$21,005.58
Rate for Payer: Molina Medicare/Medicaid	$20,092.29
Rate for Payer: Nomi Health Commercial	$54,797.16
Rate for Payer: PACE Medicare	$17,352.43
Rate for Payer: PACE SWMI	$18,265.72
Rate for Payer: PHP Medicare Advantage	$18,265.72
Rate for Payer: Priority Health Choice Medicaid	$9,552.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$59,069.70
Rate for Payer: Priority Health Medicare	$18,265.72
Rate for Payer: Priority Health Tiered Network	$47,255.76
Rate for Payer: Railroad Medicare Medicare	$18,265.72
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18,265.72
Rate for Payer: UHC Medicaid	$9,552.97
Rate for Payer: UHCCP Medicaid	$9,552.97
Rate for Payer: VA VA	$18,265.72

REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED

Facility

$13,456.32

Service Code	CPT 37225
Hospital Revenue Code	360
Min. Negotiated Rate	$13,456.32
Max. Negotiated Rate	$13,456.32
Rate for Payer: BCBS Trust/PPO	$13,456.32
Rate for Payer: BCN Commercial	$13,456.32

REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL ANGIOPLASTY

Facility

$8,022.52

Service Code	CPT 37224
Hospital Revenue Code	360
Min. Negotiated Rate	$8,022.52
Max. Negotiated Rate	$8,022.52
Rate for Payer: BCBS Trust/PPO	$8,022.52
Rate for Payer: BCN Commercial	$8,022.52

REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL STENT PLACEMENT(S) AND ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED

Facility

$18,867.75

Service Code	CPT 37227
Hospital Revenue Code	360
Min. Negotiated Rate	$18,867.75
Max. Negotiated Rate	$18,867.75
Rate for Payer: BCBS Trust/PPO	$18,867.75
Rate for Payer: BCN Commercial	$18,867.75

REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY

Facility

$4,301.95

Service Code	CPT 37220
Hospital Revenue Code	360
Min. Negotiated Rate	$4,301.95
Max. Negotiated Rate	$4,301.95
Rate for Payer: BCBS Trust/PPO	$4,301.95
Rate for Payer: BCN Commercial	$4,301.95

REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED

Facility

$10,334.49

Service Code	CPT 37221
Hospital Revenue Code	360
Min. Negotiated Rate	$10,334.49
Max. Negotiated Rate	$10,334.49
Rate for Payer: BCBS Trust/PPO	$10,334.49
Rate for Payer: BCN Commercial	$10,334.49

REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC VASCULAR TERRITORY, WITH TRANSLUMINAL STENT PLACEMENT, INCLUDING TRANSLUMINAL ANGIOPLASTY WHEN PERFORMED, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE STENT PLACEMENT AND ANGIOPLASTY WHEN PERFORMED, WITHIN THE SAME ARTERY, UNILATERAL; COMPLEX LESION, INITIAL VESSEL

Facility

$37,198.61

Service Code	CPT 37260
Hospital Revenue Code	360
Min. Negotiated Rate	$6,015.90
Max. Negotiated Rate	$37,198.61
Rate for Payer: Aetna Medicare	$11,962.79
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,378.35
Rate for Payer: Amish Plain Church Group Commercial	$14,378.35
Rate for Payer: BCBS Complete	$6,317.27
Rate for Payer: BCBS MAPPO	$11,502.68
Rate for Payer: BCN Medicare Advantage	$11,502.68
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,502.68
Rate for Payer: Mclaren Medicaid	$11,502.68
Rate for Payer: Mclaren Medicare	$11,502.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12,077.81
Rate for Payer: Meridian Medicaid	$12,077.81
Rate for Payer: MI Amish Medical Board Commercial	$13,228.08
Rate for Payer: Molina Medicare/Medicaid	$12,652.95
Rate for Payer: Nomi Health Commercial	$34,508.04
Rate for Payer: PACE Medicare	$10,927.55
Rate for Payer: PACE SWMI	$11,502.68
Rate for Payer: PHP Medicare Advantage	$11,502.68
Rate for Payer: Priority Health Choice Medicaid	$6,015.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$37,198.61
Rate for Payer: Priority Health Medicare	$11,502.68
Rate for Payer: Priority Health Tiered Network	$29,758.89
Rate for Payer: Railroad Medicare Medicare	$11,502.68
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$11,502.68
Rate for Payer: UHC Medicaid	$6,015.90
Rate for Payer: UHCCP Medicaid	$6,015.90
Rate for Payer: VA VA	$11,502.68

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