|
HC RETICULOCYTE COUNT
|
Facility
|
OP
|
$41.51
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
30500010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$37.36 |
| Rate for Payer: Aetna American Axle |
$26.98
|
| Rate for Payer: Aetna Commercial |
$35.28
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: BCBS Complete |
$3.13
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.37
|
| Rate for Payer: BCN Commercial |
$5.37
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$33.21
|
| Rate for Payer: Cash Price |
$33.21
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$29.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$37.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.13
|
| Rate for Payer: Mclaren Medicaid |
$2.99
|
| Rate for Payer: Mclaren Medicare |
$5.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: Meridian Medicaid |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.28
|
| Rate for Payer: Nomi Health Commercial |
$8.36
|
| Rate for Payer: PACE Medicare |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$35.28
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.57
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health Narrow Network |
$4.46
|
| Rate for Payer: Priority Health SBD |
$26.15
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Exchange |
$5.57
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: UHCCP Medicaid |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$15.36
|
| Rate for Payer: VA VA |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.13
|
|
|
HC REVAS ADD.VESSEL/DES
|
Facility
|
IP
|
$19,352.18
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,514.96 |
| Max. Negotiated Rate |
$17,416.96 |
| Rate for Payer: Aetna American Axle |
$12,578.92
|
| Rate for Payer: Aetna Commercial |
$16,449.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,578.92
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cofinity Commercial |
$13,546.53
|
| Rate for Payer: Cofinity Commercial |
$16,642.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,546.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,481.74
|
| Rate for Payer: Healthscope Commercial |
$17,416.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,546.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,514.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,449.35
|
| Rate for Payer: PHP Commercial |
$16,449.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,578.92
|
| Rate for Payer: Priority Health SBD |
$12,191.87
|
| Rate for Payer: UMR Bronson Commercial |
$8,514.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,514.14
|
|
|
HC REVAS ADD.VESSEL/DES
|
Facility
|
OP
|
$19,352.18
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$17,416.96 |
| Rate for Payer: Aetna American Axle |
$12,578.92
|
| Rate for Payer: Aetna Commercial |
$16,449.35
|
| Rate for Payer: Aetna Medicare |
$9,676.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,578.92
|
| Rate for Payer: BCBS Complete |
$7,740.87
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cofinity Commercial |
$16,642.87
|
| Rate for Payer: Cofinity Commercial |
$13,546.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,546.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,481.74
|
| Rate for Payer: Healthscope Commercial |
$17,416.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,546.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,514.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,449.35
|
| Rate for Payer: PHP Commercial |
$16,449.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,578.92
|
| Rate for Payer: Priority Health SBD |
$12,191.87
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UMR Bronson Commercial |
$7,160.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,514.14
|
|
|
HC REVAS ADD.VESSEL/STENT
|
Facility
|
OP
|
$19,352.18
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$734.48 |
| Max. Negotiated Rate |
$17,416.96 |
| Rate for Payer: Aetna American Axle |
$12,578.92
|
| Rate for Payer: Aetna Commercial |
$16,449.35
|
| Rate for Payer: Aetna Medicare |
$9,676.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,578.92
|
| Rate for Payer: BCBS Complete |
$7,740.87
|
| Rate for Payer: BCBS Trust/PPO |
$734.48
|
| Rate for Payer: BCN Commercial |
$734.48
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cofinity Commercial |
$16,642.87
|
| Rate for Payer: Cofinity Commercial |
$13,546.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,546.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,481.74
|
| Rate for Payer: Healthscope Commercial |
$17,416.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,546.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,514.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,449.35
|
| Rate for Payer: PHP Commercial |
$16,449.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,578.92
|
| Rate for Payer: Priority Health SBD |
$12,191.87
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UMR Bronson Commercial |
$7,160.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,514.14
|
|
|
HC REVAS ADD.VESSEL/STENT
|
Facility
|
IP
|
$19,352.18
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,514.96 |
| Max. Negotiated Rate |
$17,416.96 |
| Rate for Payer: Aetna American Axle |
$12,578.92
|
| Rate for Payer: Aetna Commercial |
$16,449.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,578.92
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cofinity Commercial |
$13,546.53
|
| Rate for Payer: Cofinity Commercial |
$16,642.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,546.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,481.74
|
| Rate for Payer: Healthscope Commercial |
$17,416.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,546.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,514.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,449.35
|
| Rate for Payer: PHP Commercial |
$16,449.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,578.92
|
| Rate for Payer: Priority Health SBD |
$12,191.87
|
| Rate for Payer: UMR Bronson Commercial |
$8,514.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,514.14
|
|
|
HC REVAS CABG ADD.BRANCH
|
Facility
|
OP
|
$19,101.90
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
48100082
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$654.19 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna American Axle |
$12,416.24
|
| Rate for Payer: Aetna Commercial |
$16,236.62
|
| Rate for Payer: Aetna Medicare |
$9,550.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,416.24
|
| Rate for Payer: BCBS Complete |
$7,640.76
|
| Rate for Payer: BCBS Trust/PPO |
$654.19
|
| Rate for Payer: BCN Commercial |
$654.19
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Cofinity Commercial |
$13,371.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,371.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,371.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,326.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.62
|
| Rate for Payer: PHP Commercial |
$16,236.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health SBD |
$12,034.20
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UMR Bronson Commercial |
$7,067.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,326.42
|
|
|
HC REVAS CABG ADD.BRANCH
|
Facility
|
IP
|
$19,101.90
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
48100082
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,404.84 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna American Axle |
$12,416.24
|
| Rate for Payer: Aetna Commercial |
$16,236.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,416.24
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$13,371.33
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,371.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,371.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,326.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.62
|
| Rate for Payer: PHP Commercial |
$16,236.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health SBD |
$12,034.20
|
| Rate for Payer: UMR Bronson Commercial |
$8,404.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,326.42
|
|
|
HC REVAS CABG VES/BRANCH
|
Facility
|
OP
|
$29,158.60
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$528.57 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna American Axle |
$18,953.09
|
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,953.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$528.57
|
| Rate for Payer: BCN Commercial |
$528.57
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Cofinity Commercial |
$20,411.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,411.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,411.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,868.95
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Priority Health SBD |
$18,369.92
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$622.66
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$566.05
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$5,955.64
|
| Rate for Payer: UMR Bronson Commercial |
$10,788.68
|
| Rate for Payer: VA VA |
$11,111.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,868.95
|
|
|
HC REVAS CABG VES/BRANCH
|
Facility
|
IP
|
$29,158.60
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,829.78 |
| Max. Negotiated Rate |
$26,242.74 |
| Rate for Payer: Aetna American Axle |
$18,953.09
|
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,953.09
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$20,411.02
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,411.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,411.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,868.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health SBD |
$18,369.92
|
| Rate for Payer: UMR Bronson Commercial |
$12,829.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,868.95
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY
|
Facility
|
OP
|
$31,416.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
48100124
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,955.64 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna American Axle |
$20,420.40
|
| Rate for Payer: Aetna Commercial |
$26,703.60
|
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,420.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cofinity Commercial |
$27,017.76
|
| Rate for Payer: Cofinity Commercial |
$21,991.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,991.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,132.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$28,274.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,991.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,562.00
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,703.60
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$26,703.60
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,420.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Priority Health SBD |
$19,792.08
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,277.09
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$21,234.73
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$5,955.64
|
| Rate for Payer: UMR Bronson Commercial |
$11,623.92
|
| Rate for Payer: VA VA |
$11,111.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,562.00
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY
|
Facility
|
IP
|
$31,416.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
48100124
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,823.04 |
| Max. Negotiated Rate |
$28,274.40 |
| Rate for Payer: Aetna American Axle |
$20,420.40
|
| Rate for Payer: Aetna Commercial |
$26,703.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,420.40
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cofinity Commercial |
$21,991.20
|
| Rate for Payer: Cofinity Commercial |
$27,017.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,991.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,132.80
|
| Rate for Payer: Healthscope Commercial |
$28,274.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,991.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,562.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,703.60
|
| Rate for Payer: PHP Commercial |
$26,703.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,420.40
|
| Rate for Payer: Priority Health SBD |
$19,792.08
|
| Rate for Payer: UMR Bronson Commercial |
$13,823.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,562.00
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH ATHERECTOMY
|
Facility
|
OP
|
$50,051.40
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
48100126
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,430.19 |
| Max. Negotiated Rate |
$55,296.52 |
| Rate for Payer: Aetna American Axle |
$32,533.41
|
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna Medicare |
$18,297.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,035.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,538.55
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: Nomi Health Commercial |
$36,946.64
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,296.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$44,237.22
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,524.34
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$33,623.21
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: UMR Bronson Commercial |
$18,519.02
|
| Rate for Payer: VA VA |
$17,593.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,538.55
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH ATHERECTOMY
|
Facility
|
IP
|
$50,051.40
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
48100126
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$22,022.62 |
| Max. Negotiated Rate |
$45,046.26 |
| Rate for Payer: Aetna American Axle |
$32,533.41
|
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,035.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,538.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: UMR Bronson Commercial |
$22,022.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,538.55
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH STENT
|
Facility
|
IP
|
$50,051.40
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
48100125
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$22,022.62 |
| Max. Negotiated Rate |
$45,046.26 |
| Rate for Payer: Aetna American Axle |
$32,533.41
|
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,035.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,538.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: UMR Bronson Commercial |
$22,022.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,538.55
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH STENT
|
Facility
|
OP
|
$50,051.40
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
48100125
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,430.19 |
| Max. Negotiated Rate |
$55,296.52 |
| Rate for Payer: Aetna American Axle |
$32,533.41
|
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna Medicare |
$18,297.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,035.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,538.55
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: Nomi Health Commercial |
$36,946.64
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,296.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$44,237.22
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,524.34
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$33,623.21
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: UMR Bronson Commercial |
$18,519.02
|
| Rate for Payer: VA VA |
$17,593.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,538.55
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH STENT AND ATHERECT
|
Facility
|
IP
|
$50,051.40
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
48100127
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$22,022.62 |
| Max. Negotiated Rate |
$45,046.26 |
| Rate for Payer: Aetna American Axle |
$32,533.41
|
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,035.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,538.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: UMR Bronson Commercial |
$22,022.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,538.55
|
|
|
HC REVASC LOWER EXTR INTRAVASC LITHOTRIPSY INCL ANGIOPLASTY WITH STENT AND ATHERECT
|
Facility
|
OP
|
$50,051.40
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
48100127
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,430.19 |
| Max. Negotiated Rate |
$55,296.52 |
| Rate for Payer: Aetna American Axle |
$32,533.41
|
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna Medicare |
$18,297.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,035.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,538.55
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: Nomi Health Commercial |
$36,946.64
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,296.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$44,237.22
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,524.34
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$33,623.21
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: UMR Bronson Commercial |
$18,519.02
|
| Rate for Payer: VA VA |
$17,593.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,538.55
|
|
|
HC REVASC STENT TIB PERONL UNI INITIAL
|
Facility
|
OP
|
$11,826.66
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
36100174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$666.25 |
| Max. Negotiated Rate |
$55,296.52 |
| Rate for Payer: Aetna American Axle |
$7,687.33
|
| Rate for Payer: Aetna Commercial |
$10,052.66
|
| Rate for Payer: Aetna Medicare |
$18,297.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,687.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$13,142.49
|
| Rate for Payer: BCN Commercial |
$13,142.49
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$9,461.33
|
| Rate for Payer: Cash Price |
$9,461.33
|
| Rate for Payer: Cash Price |
$9,461.33
|
| Rate for Payer: Cofinity Commercial |
$8,278.66
|
| Rate for Payer: Cofinity Commercial |
$10,170.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,278.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,461.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$10,643.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,278.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,870.00
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,052.66
|
| Rate for Payer: Nomi Health Commercial |
$36,946.64
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$10,052.66
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,687.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,296.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$44,237.22
|
| Rate for Payer: Priority Health SBD |
$7,450.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$732.88
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$666.25
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: UMR Bronson Commercial |
$4,375.86
|
| Rate for Payer: VA VA |
$17,593.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,870.00
|
|
|
HC REVASC STENT TIB PERONL UNI INITIAL
|
Facility
|
IP
|
$11,826.66
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
36100174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,203.73 |
| Max. Negotiated Rate |
$10,643.99 |
| Rate for Payer: Aetna American Axle |
$7,687.33
|
| Rate for Payer: Aetna Commercial |
$10,052.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,687.33
|
| Rate for Payer: Cash Price |
$9,461.33
|
| Rate for Payer: Cofinity Commercial |
$10,170.93
|
| Rate for Payer: Cofinity Commercial |
$8,278.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,278.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,461.33
|
| Rate for Payer: Healthscope Commercial |
$10,643.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,278.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,870.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,052.66
|
| Rate for Payer: PHP Commercial |
$10,052.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,687.33
|
| Rate for Payer: Priority Health SBD |
$7,450.80
|
| Rate for Payer: UMR Bronson Commercial |
$5,203.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,870.00
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY
|
Facility
|
OP
|
$31,416.00
|
|
|
Service Code
|
CPT C9772
|
| Hospital Charge Code |
48100128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,955.64 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna American Axle |
$20,420.40
|
| Rate for Payer: Aetna Commercial |
$26,703.60
|
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,420.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cofinity Commercial |
$27,017.76
|
| Rate for Payer: Cofinity Commercial |
$21,991.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,991.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,132.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$28,274.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,991.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,562.00
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,703.60
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$26,703.60
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,420.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Priority Health SBD |
$19,792.08
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,277.09
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$21,234.73
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$5,955.64
|
| Rate for Payer: UMR Bronson Commercial |
$11,623.92
|
| Rate for Payer: VA VA |
$11,111.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,562.00
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY
|
Facility
|
IP
|
$31,416.00
|
|
|
Service Code
|
CPT C9772
|
| Hospital Charge Code |
48100128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,823.04 |
| Max. Negotiated Rate |
$28,274.40 |
| Rate for Payer: Aetna American Axle |
$20,420.40
|
| Rate for Payer: Aetna Commercial |
$26,703.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,420.40
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cofinity Commercial |
$21,991.20
|
| Rate for Payer: Cofinity Commercial |
$27,017.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,991.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,132.80
|
| Rate for Payer: Healthscope Commercial |
$28,274.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,991.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,562.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,703.60
|
| Rate for Payer: PHP Commercial |
$26,703.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,420.40
|
| Rate for Payer: Priority Health SBD |
$19,792.08
|
| Rate for Payer: UMR Bronson Commercial |
$13,823.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,562.00
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH ATHERECTOMY
|
Facility
|
OP
|
$50,051.40
|
|
|
Service Code
|
CPT C9774
|
| Hospital Charge Code |
48100130
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,430.19 |
| Max. Negotiated Rate |
$55,296.52 |
| Rate for Payer: Aetna American Axle |
$32,533.41
|
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna Medicare |
$18,297.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,035.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,538.55
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: Nomi Health Commercial |
$36,946.64
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,296.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$44,237.22
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,524.34
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$33,623.21
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: UMR Bronson Commercial |
$18,519.02
|
| Rate for Payer: VA VA |
$17,593.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,538.55
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH ATHERECTOMY
|
Facility
|
IP
|
$50,051.40
|
|
|
Service Code
|
CPT C9774
|
| Hospital Charge Code |
48100130
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$22,022.62 |
| Max. Negotiated Rate |
$45,046.26 |
| Rate for Payer: Aetna American Axle |
$32,533.41
|
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,035.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,538.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: UMR Bronson Commercial |
$22,022.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,538.55
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH STENT
|
Facility
|
IP
|
$50,051.40
|
|
|
Service Code
|
CPT C9773
|
| Hospital Charge Code |
48100129
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$22,022.62 |
| Max. Negotiated Rate |
$45,046.26 |
| Rate for Payer: Aetna American Axle |
$32,533.41
|
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,035.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,538.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: UMR Bronson Commercial |
$22,022.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,538.55
|
|
|
HC REVASC TIBIAL/PERIONEAL LITHOTRIPSY INCL ANGIOPLASTY WITH STENT
|
Facility
|
OP
|
$50,051.40
|
|
|
Service Code
|
CPT C9773
|
| Hospital Charge Code |
48100129
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,430.19 |
| Max. Negotiated Rate |
$55,296.52 |
| Rate for Payer: Aetna American Axle |
$32,533.41
|
| Rate for Payer: Aetna Commercial |
$42,543.69
|
| Rate for Payer: Aetna Medicare |
$18,297.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,533.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$43,044.20
|
| Rate for Payer: Cofinity Commercial |
$35,035.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$35,035.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$45,046.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,035.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,538.55
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: Nomi Health Commercial |
$36,946.64
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$42,543.69
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,296.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$44,237.22
|
| Rate for Payer: Priority Health SBD |
$31,532.38
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,524.34
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$33,623.21
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: UMR Bronson Commercial |
$18,519.02
|
| Rate for Payer: VA VA |
$17,593.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,538.55
|
|
