|
HC RESP VIRAL PANEL RP2.1
|
Facility
|
OP
|
$624.24
|
|
|
Service Code
|
HCPCS 0202U
|
| Hospital Charge Code |
30000162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$223.39 |
| Max. Negotiated Rate |
$646.01 |
| Rate for Payer: Aetna Commercial |
$561.82
|
| Rate for Payer: Aetna Medicare |
$416.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: ASR ASR |
$605.51
|
| Rate for Payer: ASR Commercial |
$605.51
|
| Rate for Payer: BCBS Complete |
$234.56
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$511.19
|
| Rate for Payer: BCN Commercial |
$483.97
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cofinity Commercial |
$586.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$624.24
|
| Rate for Payer: Healthscope Whirlpool |
$605.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$416.78
|
| Rate for Payer: Mclaren Commercial |
$561.82
|
| Rate for Payer: Mclaren Medicaid |
$223.39
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: Meridian Medicaid |
$234.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.60
|
| Rate for Payer: Nomi Health Commercial |
$511.88
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$458.46
|
| Rate for Payer: PHP Medicaid |
$223.39
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$405.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.96
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health Narrow Network |
$437.59
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$549.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.78
|
| Rate for Payer: UHC Exchange |
$646.01
|
| Rate for Payer: UHC Medicare Advantage |
$416.78
|
| Rate for Payer: UHCCP DNSP |
$416.78
|
| Rate for Payer: UHCCP Medicaid |
$223.39
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC RESTORE HYDROGEL 3 OZ
|
Facility
|
OP
|
$18.85
|
|
| Hospital Charge Code |
27100015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Commercial |
$16.96
|
| Rate for Payer: Aetna Medicare |
$9.42
|
| Rate for Payer: ASR ASR |
$18.28
|
| Rate for Payer: ASR Commercial |
$18.28
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS Trust/PPO |
$15.44
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$18.85
|
| Rate for Payer: Healthscope Whirlpool |
$18.28
|
| Rate for Payer: Mclaren Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.02
|
| Rate for Payer: Nomi Health Commercial |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.52
|
| Rate for Payer: Priority Health Narrow Network |
$13.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.59
|
|
|
HC RESTORE HYDROGEL 3 OZ
|
Facility
|
IP
|
$18.85
|
|
| Hospital Charge Code |
27100015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Commercial |
$16.96
|
| Rate for Payer: ASR ASR |
$18.28
|
| Rate for Payer: ASR Commercial |
$18.28
|
| Rate for Payer: BCBS Trust/PPO |
$15.36
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$18.85
|
| Rate for Payer: Healthscope Whirlpool |
$18.28
|
| Rate for Payer: Mclaren Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.02
|
| Rate for Payer: Nomi Health Commercial |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.59
|
|
|
HC RESUPERF WND BODY <2.5 CM
|
Facility
|
OP
|
$275.71
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
76100181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Aetna Commercial |
$248.14
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$267.44
|
| Rate for Payer: ASR Commercial |
$267.44
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$225.78
|
| Rate for Payer: BCN Commercial |
$213.76
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cofinity Commercial |
$259.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$275.71
|
| Rate for Payer: Healthscope Whirlpool |
$267.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$248.14
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.35
|
| Rate for Payer: Nomi Health Commercial |
$226.08
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC RESUPERF WND BODY <2.5 CM
|
Facility
|
IP
|
$275.71
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
76100181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.21 |
| Max. Negotiated Rate |
$275.71 |
| Rate for Payer: Aetna Commercial |
$248.14
|
| Rate for Payer: ASR ASR |
$267.44
|
| Rate for Payer: ASR Commercial |
$267.44
|
| Rate for Payer: BCBS Trust/PPO |
$224.68
|
| Rate for Payer: BCN Commercial |
$213.76
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cofinity Commercial |
$259.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.57
|
| Rate for Payer: Healthscope Commercial |
$275.71
|
| Rate for Payer: Healthscope Whirlpool |
$267.44
|
| Rate for Payer: Mclaren Commercial |
$248.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.35
|
| Rate for Payer: Nomi Health Commercial |
$226.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.62
|
|
|
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 |
$41.51 |
| Rate for Payer: Aetna Commercial |
$37.36
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: ASR ASR |
$40.26
|
| Rate for Payer: ASR Commercial |
$40.26
|
| Rate for Payer: BCBS Complete |
$3.13
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$33.99
|
| Rate for Payer: BCN Commercial |
$32.18
|
| 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 |
$39.02
|
| 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 |
$41.51
|
| Rate for Payer: Healthscope Whirlpool |
$40.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.57
|
| Rate for Payer: Mclaren Commercial |
$37.36
|
| 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 |
$34.04
|
| Rate for Payer: PACE Medicare |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$6.13
|
| Rate for Payer: PHP Medicaid |
$2.99
|
| 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 |
$36.37
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health Narrow Network |
$29.10
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Exchange |
$8.63
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: UHCCP DNSP |
$5.57
|
| Rate for Payer: UHCCP Medicaid |
$2.99
|
| Rate for Payer: VA VA |
$5.57
|
|
|
HC RETICULOCYTE COUNT
|
Facility
|
IP
|
$41.51
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
30500010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.98 |
| Max. Negotiated Rate |
$41.51 |
| Rate for Payer: Aetna Commercial |
$37.36
|
| Rate for Payer: ASR ASR |
$40.26
|
| Rate for Payer: ASR Commercial |
$40.26
|
| Rate for Payer: BCBS Trust/PPO |
$33.83
|
| Rate for Payer: BCN Commercial |
$32.18
|
| Rate for Payer: Cash Price |
$33.21
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.21
|
| Rate for Payer: Healthscope Commercial |
$41.51
|
| Rate for Payer: Healthscope Whirlpool |
$40.26
|
| Rate for Payer: Mclaren Commercial |
$37.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.28
|
| Rate for Payer: Nomi Health Commercial |
$34.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.53
|
|
|
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 |
$7,110.45 |
| Max. Negotiated Rate |
$19,352.18 |
| Rate for Payer: Aetna Commercial |
$17,416.96
|
| Rate for Payer: Aetna Medicare |
$9,676.09
|
| Rate for Payer: ASR ASR |
$18,771.61
|
| Rate for Payer: ASR Commercial |
$18,771.61
|
| Rate for Payer: BCBS Complete |
$7,740.87
|
| Rate for Payer: BCBS Trust/PPO |
$15,847.50
|
| Rate for Payer: BCN Commercial |
$15,003.75
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cofinity Commercial |
$18,191.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,481.74
|
| Rate for Payer: Healthscope Commercial |
$19,352.18
|
| Rate for Payer: Healthscope Whirlpool |
$18,771.61
|
| Rate for Payer: Mclaren Commercial |
$17,416.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,449.35
|
| Rate for Payer: Nomi Health Commercial |
$15,868.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,578.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,888.06
|
| Rate for Payer: Priority Health Narrow Network |
$7,110.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,029.92
|
|
|
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 |
$12,578.92 |
| Max. Negotiated Rate |
$19,352.18 |
| Rate for Payer: Aetna Commercial |
$17,416.96
|
| Rate for Payer: ASR ASR |
$18,771.61
|
| Rate for Payer: ASR Commercial |
$18,771.61
|
| Rate for Payer: BCBS Trust/PPO |
$15,770.09
|
| Rate for Payer: BCN Commercial |
$15,003.75
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cofinity Commercial |
$18,191.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,481.74
|
| Rate for Payer: Healthscope Commercial |
$19,352.18
|
| Rate for Payer: Healthscope Whirlpool |
$18,771.61
|
| Rate for Payer: Mclaren Commercial |
$17,416.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,449.35
|
| Rate for Payer: Nomi Health Commercial |
$15,868.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,578.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,029.92
|
|
|
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 |
$12,578.92 |
| Max. Negotiated Rate |
$19,352.18 |
| Rate for Payer: Aetna Commercial |
$17,416.96
|
| Rate for Payer: ASR ASR |
$18,771.61
|
| Rate for Payer: ASR Commercial |
$18,771.61
|
| Rate for Payer: BCBS Trust/PPO |
$15,770.09
|
| Rate for Payer: BCN Commercial |
$15,003.75
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cofinity Commercial |
$18,191.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,481.74
|
| Rate for Payer: Healthscope Commercial |
$19,352.18
|
| Rate for Payer: Healthscope Whirlpool |
$18,771.61
|
| Rate for Payer: Mclaren Commercial |
$17,416.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,449.35
|
| Rate for Payer: Nomi Health Commercial |
$15,868.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,578.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,029.92
|
|
|
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 |
$5,596.67 |
| Max. Negotiated Rate |
$19,352.18 |
| Rate for Payer: Aetna Commercial |
$17,416.96
|
| Rate for Payer: Aetna Medicare |
$9,676.09
|
| Rate for Payer: ASR ASR |
$18,771.61
|
| Rate for Payer: ASR Commercial |
$18,771.61
|
| Rate for Payer: BCBS Complete |
$7,740.87
|
| Rate for Payer: BCBS Trust/PPO |
$15,847.50
|
| Rate for Payer: BCN Commercial |
$15,003.75
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cash Price |
$15,481.74
|
| Rate for Payer: Cofinity Commercial |
$18,191.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,481.74
|
| Rate for Payer: Healthscope Commercial |
$19,352.18
|
| Rate for Payer: Healthscope Whirlpool |
$18,771.61
|
| Rate for Payer: Mclaren Commercial |
$17,416.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,449.35
|
| Rate for Payer: Nomi Health Commercial |
$15,868.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,578.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,995.84
|
| Rate for Payer: Priority Health Narrow Network |
$5,596.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,029.92
|
|
|
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 |
$12,416.24 |
| Max. Negotiated Rate |
$19,101.90 |
| Rate for Payer: Aetna Commercial |
$17,191.71
|
| Rate for Payer: ASR ASR |
$18,528.84
|
| Rate for Payer: ASR Commercial |
$18,528.84
|
| Rate for Payer: BCBS Trust/PPO |
$15,566.14
|
| Rate for Payer: BCN Commercial |
$14,809.70
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$17,955.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$19,101.90
|
| Rate for Payer: Healthscope Whirlpool |
$18,528.84
|
| Rate for Payer: Mclaren Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.62
|
| Rate for Payer: Nomi Health Commercial |
$15,663.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,809.67
|
|
|
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 |
$5,596.67 |
| Max. Negotiated Rate |
$19,101.90 |
| Rate for Payer: Aetna Commercial |
$17,191.71
|
| Rate for Payer: Aetna Medicare |
$9,550.95
|
| Rate for Payer: ASR ASR |
$18,528.84
|
| Rate for Payer: ASR Commercial |
$18,528.84
|
| Rate for Payer: BCBS Complete |
$7,640.76
|
| Rate for Payer: BCBS Trust/PPO |
$15,642.55
|
| Rate for Payer: BCN Commercial |
$14,809.70
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$17,955.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$19,101.90
|
| Rate for Payer: Healthscope Whirlpool |
$18,528.84
|
| Rate for Payer: Mclaren Commercial |
$17,191.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.62
|
| Rate for Payer: Nomi Health Commercial |
$15,663.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,995.84
|
| Rate for Payer: Priority Health Narrow Network |
$5,596.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,809.67
|
|
|
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 |
$5,596.67 |
| Max. Negotiated Rate |
$29,158.60 |
| Rate for Payer: Aetna Commercial |
$26,242.74
|
| Rate for Payer: Aetna Medicare |
$11,111.26
|
| 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: ASR ASR |
$28,283.84
|
| Rate for Payer: ASR Commercial |
$28,283.84
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$23,877.98
|
| Rate for Payer: BCN Commercial |
$22,606.66
|
| 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: Cofinity Commercial |
$27,409.08
|
| 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 |
$29,158.60
|
| Rate for Payer: Healthscope Whirlpool |
$28,283.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,111.26
|
| Rate for Payer: Mclaren Commercial |
$26,242.74
|
| 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 |
$23,910.05
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$12,222.39
|
| Rate for Payer: PHP Medicaid |
$5,955.64
|
| 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 |
$6,995.84
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$5,596.67
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,659.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$17,222.45
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP DNSP |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$5,955.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
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 |
$18,953.09 |
| Max. Negotiated Rate |
$29,158.60 |
| Rate for Payer: Aetna Commercial |
$26,242.74
|
| Rate for Payer: ASR ASR |
$28,283.84
|
| Rate for Payer: ASR Commercial |
$28,283.84
|
| Rate for Payer: BCBS Trust/PPO |
$23,761.34
|
| Rate for Payer: BCN Commercial |
$22,606.66
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$27,409.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Healthscope Commercial |
$29,158.60
|
| Rate for Payer: Healthscope Whirlpool |
$28,283.84
|
| Rate for Payer: Mclaren Commercial |
$26,242.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,910.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,659.57
|
|
|
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 |
$20,420.40 |
| Max. Negotiated Rate |
$31,416.00 |
| Rate for Payer: Aetna Commercial |
$28,274.40
|
| Rate for Payer: ASR ASR |
$30,473.52
|
| Rate for Payer: ASR Commercial |
$30,473.52
|
| Rate for Payer: BCBS Trust/PPO |
$25,600.90
|
| Rate for Payer: BCN Commercial |
$24,356.82
|
| Rate for Payer: Cash Price |
$25,132.80
|
| Rate for Payer: Cofinity Commercial |
$29,531.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,132.80
|
| Rate for Payer: Healthscope Commercial |
$31,416.00
|
| Rate for Payer: Healthscope Whirlpool |
$30,473.52
|
| Rate for Payer: Mclaren Commercial |
$28,274.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,703.60
|
| Rate for Payer: Nomi Health Commercial |
$25,761.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,420.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27,646.08
|
|
|
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 |
$31,416.00 |
| Rate for Payer: Aetna Commercial |
$28,274.40
|
| Rate for Payer: Aetna Medicare |
$11,111.26
|
| 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: ASR ASR |
$30,473.52
|
| Rate for Payer: ASR Commercial |
$30,473.52
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$25,726.56
|
| Rate for Payer: BCN Commercial |
$24,356.82
|
| 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: Cofinity Commercial |
$29,531.04
|
| 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 |
$31,416.00
|
| Rate for Payer: Healthscope Whirlpool |
$30,473.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,111.26
|
| Rate for Payer: Mclaren Commercial |
$28,274.40
|
| 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 |
$25,761.12
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$12,222.39
|
| Rate for Payer: PHP Medicaid |
$5,955.64
|
| 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 |
$27,526.70
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$22,022.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27,646.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$17,222.45
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP DNSP |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$5,955.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
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 |
$50,051.40 |
| Rate for Payer: Aetna Commercial |
$45,046.26
|
| Rate for Payer: Aetna Medicare |
$17,593.64
|
| 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: ASR ASR |
$48,549.86
|
| Rate for Payer: ASR Commercial |
$48,549.86
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$40,987.09
|
| Rate for Payer: BCN Commercial |
$38,804.85
|
| 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: Cofinity Commercial |
$47,048.32
|
| 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 |
$50,051.40
|
| Rate for Payer: Healthscope Whirlpool |
$48,549.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,593.64
|
| Rate for Payer: Mclaren Commercial |
$45,046.26
|
| 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 |
$41,042.15
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$19,353.00
|
| Rate for Payer: PHP Medicaid |
$9,430.19
|
| 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 |
$43,855.04
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$35,086.03
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,045.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$27,270.14
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP DNSP |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
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 |
$32,533.41 |
| Max. Negotiated Rate |
$50,051.40 |
| Rate for Payer: Aetna Commercial |
$45,046.26
|
| Rate for Payer: ASR ASR |
$48,549.86
|
| Rate for Payer: ASR Commercial |
$48,549.86
|
| Rate for Payer: BCBS Trust/PPO |
$40,786.89
|
| Rate for Payer: BCN Commercial |
$38,804.85
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$47,048.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Healthscope Commercial |
$50,051.40
|
| Rate for Payer: Healthscope Whirlpool |
$48,549.86
|
| Rate for Payer: Mclaren Commercial |
$45,046.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: Nomi Health Commercial |
$41,042.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,045.23
|
|
|
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 |
$50,051.40 |
| Rate for Payer: Aetna Commercial |
$45,046.26
|
| Rate for Payer: Aetna Medicare |
$17,593.64
|
| 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: ASR ASR |
$48,549.86
|
| Rate for Payer: ASR Commercial |
$48,549.86
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$40,987.09
|
| Rate for Payer: BCN Commercial |
$38,804.85
|
| 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: Cofinity Commercial |
$47,048.32
|
| 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 |
$50,051.40
|
| Rate for Payer: Healthscope Whirlpool |
$48,549.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,593.64
|
| Rate for Payer: Mclaren Commercial |
$45,046.26
|
| 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 |
$41,042.15
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$19,353.00
|
| Rate for Payer: PHP Medicaid |
$9,430.19
|
| 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 |
$43,855.04
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$35,086.03
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,045.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$27,270.14
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP DNSP |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
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 |
$32,533.41 |
| Max. Negotiated Rate |
$50,051.40 |
| Rate for Payer: Aetna Commercial |
$45,046.26
|
| Rate for Payer: ASR ASR |
$48,549.86
|
| Rate for Payer: ASR Commercial |
$48,549.86
|
| Rate for Payer: BCBS Trust/PPO |
$40,786.89
|
| Rate for Payer: BCN Commercial |
$38,804.85
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$47,048.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Healthscope Commercial |
$50,051.40
|
| Rate for Payer: Healthscope Whirlpool |
$48,549.86
|
| Rate for Payer: Mclaren Commercial |
$45,046.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: Nomi Health Commercial |
$41,042.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,045.23
|
|
|
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 |
$50,051.40 |
| Rate for Payer: Aetna Commercial |
$45,046.26
|
| Rate for Payer: Aetna Medicare |
$17,593.64
|
| 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: ASR ASR |
$48,549.86
|
| Rate for Payer: ASR Commercial |
$48,549.86
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$40,987.09
|
| Rate for Payer: BCN Commercial |
$38,804.85
|
| 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: Cofinity Commercial |
$47,048.32
|
| 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 |
$50,051.40
|
| Rate for Payer: Healthscope Whirlpool |
$48,549.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,593.64
|
| Rate for Payer: Mclaren Commercial |
$45,046.26
|
| 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 |
$41,042.15
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$19,353.00
|
| Rate for Payer: PHP Medicaid |
$9,430.19
|
| 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 |
$43,855.04
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$35,086.03
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,045.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$27,270.14
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP DNSP |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
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 |
$32,533.41 |
| Max. Negotiated Rate |
$50,051.40 |
| Rate for Payer: Aetna Commercial |
$45,046.26
|
| Rate for Payer: ASR ASR |
$48,549.86
|
| Rate for Payer: ASR Commercial |
$48,549.86
|
| Rate for Payer: BCBS Trust/PPO |
$40,786.89
|
| Rate for Payer: BCN Commercial |
$38,804.85
|
| Rate for Payer: Cash Price |
$40,041.12
|
| Rate for Payer: Cofinity Commercial |
$47,048.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,041.12
|
| Rate for Payer: Healthscope Commercial |
$50,051.40
|
| Rate for Payer: Healthscope Whirlpool |
$48,549.86
|
| Rate for Payer: Mclaren Commercial |
$45,046.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,543.69
|
| Rate for Payer: Nomi Health Commercial |
$41,042.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32,533.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,045.23
|
|
|
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 |
$7,687.33 |
| Max. Negotiated Rate |
$27,270.14 |
| Rate for Payer: Aetna Commercial |
$10,643.99
|
| Rate for Payer: Aetna Medicare |
$17,593.64
|
| 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: ASR ASR |
$11,471.86
|
| Rate for Payer: ASR Commercial |
$11,471.86
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$9,684.85
|
| Rate for Payer: BCN Commercial |
$9,169.21
|
| 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: Cofinity Commercial |
$11,117.06
|
| 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 |
$11,826.66
|
| Rate for Payer: Healthscope Whirlpool |
$11,471.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,593.64
|
| Rate for Payer: Mclaren Commercial |
$10,643.99
|
| 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 |
$9,697.86
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$19,353.00
|
| Rate for Payer: PHP Medicaid |
$9,430.19
|
| 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 |
$10,362.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$8,290.49
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,407.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$27,270.14
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP DNSP |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
HC REVASC STENT TIB PERONL UNI INITIAL
|
Facility
|
IP
|
$11,826.66
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
36100174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,687.33 |
| Max. Negotiated Rate |
$11,826.66 |
| Rate for Payer: Aetna Commercial |
$10,643.99
|
| Rate for Payer: ASR ASR |
$11,471.86
|
| Rate for Payer: ASR Commercial |
$11,471.86
|
| Rate for Payer: BCBS Trust/PPO |
$9,637.55
|
| Rate for Payer: BCN Commercial |
$9,169.21
|
| Rate for Payer: Cash Price |
$9,461.33
|
| Rate for Payer: Cofinity Commercial |
$11,117.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,461.33
|
| Rate for Payer: Healthscope Commercial |
$11,826.66
|
| Rate for Payer: Healthscope Whirlpool |
$11,471.86
|
| Rate for Payer: Mclaren Commercial |
$10,643.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,052.66
|
| Rate for Payer: Nomi Health Commercial |
$9,697.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,687.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,407.46
|
|
