|
HC THORACENT WO TUBE
|
Facility
|
OP
|
$1,088.19
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
36100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.78 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Commercial |
$924.96
|
| Rate for Payer: Aetna Medicare |
$581.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.71
|
| Rate for Payer: BCBS Complete |
$321.07
|
| Rate for Payer: BCBS MAPPO |
$558.97
|
| Rate for Payer: BCBS Trust/PPO |
$406.57
|
| Rate for Payer: BCN Medicare Advantage |
$558.97
|
| Rate for Payer: Cash Price |
$870.55
|
| Rate for Payer: Cash Price |
$870.55
|
| Rate for Payer: Cofinity Commercial |
$935.84
|
| Rate for Payer: Cofinity Commercial |
$761.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.97
|
| Rate for Payer: Healthscope Commercial |
$979.37
|
| Rate for Payer: Mclaren Medicaid |
$305.76
|
| Rate for Payer: Mclaren Medicare |
$558.97
|
| Rate for Payer: Meridian Medicaid |
$321.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$924.96
|
| Rate for Payer: PACE Medicare |
$531.02
|
| Rate for Payer: PACE SWMI |
$558.97
|
| Rate for Payer: PHP Commercial |
$924.96
|
| Rate for Payer: PHP Medicare Advantage |
$558.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,683.01
|
| Rate for Payer: Priority Health Medicare |
$558.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,346.41
|
| Rate for Payer: Priority Health SBD |
$685.56
|
| Rate for Payer: Railroad Medicare Medicare |
$558.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.97
|
| Rate for Payer: UHC Exchange |
$104.78
|
| Rate for Payer: UHC Medicare Advantage |
$575.74
|
| Rate for Payer: VA VA |
$558.97
|
|
|
HC THORACENT W TUBE
|
Facility
|
OP
|
$1,386.74
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$143.09 |
| Max. Negotiated Rate |
$4,378.42 |
| Rate for Payer: Aetna Commercial |
$1,178.73
|
| Rate for Payer: Aetna Medicare |
$1,482.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$901.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.30
|
| Rate for Payer: BCBS Complete |
$818.54
|
| Rate for Payer: BCBS MAPPO |
$1,425.04
|
| Rate for Payer: BCBS Trust/PPO |
$253.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.04
|
| Rate for Payer: Cash Price |
$1,109.39
|
| Rate for Payer: Cash Price |
$1,109.39
|
| Rate for Payer: Cofinity Commercial |
$1,192.60
|
| Rate for Payer: Cofinity Commercial |
$970.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.04
|
| Rate for Payer: Healthscope Commercial |
$1,248.07
|
| Rate for Payer: Mclaren Medicaid |
$779.50
|
| Rate for Payer: Mclaren Medicare |
$1,425.04
|
| Rate for Payer: Meridian Medicaid |
$818.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,496.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,178.73
|
| Rate for Payer: PACE Medicare |
$1,353.79
|
| Rate for Payer: PACE SWMI |
$1,425.04
|
| Rate for Payer: PHP Commercial |
$1,178.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,378.42
|
| Rate for Payer: Priority Health Medicare |
$1,425.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,502.74
|
| Rate for Payer: Priority Health SBD |
$873.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,425.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.40
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,425.04
|
| Rate for Payer: UHC Exchange |
$143.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,467.79
|
| Rate for Payer: VA VA |
$1,425.04
|
|
|
HC THORACENT W TUBE
|
Facility
|
IP
|
$1,386.74
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$873.65 |
| Max. Negotiated Rate |
$1,248.07 |
| Rate for Payer: Aetna Commercial |
$1,178.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$901.38
|
| Rate for Payer: Cash Price |
$1,109.39
|
| Rate for Payer: Cofinity Commercial |
$970.72
|
| Rate for Payer: Cofinity Commercial |
$1,192.60
|
| Rate for Payer: Healthscope Commercial |
$1,248.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,178.73
|
| Rate for Payer: PHP Commercial |
$1,178.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.72
|
| Rate for Payer: Priority Health SBD |
$873.65
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
IP
|
$691.08
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$435.38 |
| Max. Negotiated Rate |
$621.97 |
| Rate for Payer: Aetna Commercial |
$587.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.20
|
| Rate for Payer: Cash Price |
$552.86
|
| Rate for Payer: Cofinity Commercial |
$483.76
|
| Rate for Payer: Cofinity Commercial |
$594.33
|
| Rate for Payer: Healthscope Commercial |
$621.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.42
|
| Rate for Payer: PHP Commercial |
$587.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.76
|
| Rate for Payer: Priority Health SBD |
$435.38
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
OP
|
$691.08
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$55.01 |
| Max. Negotiated Rate |
$621.97 |
| Rate for Payer: Aetna Commercial |
$587.42
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$194.94
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$552.86
|
| Rate for Payer: Cash Price |
$552.86
|
| Rate for Payer: Cofinity Commercial |
$594.33
|
| Rate for Payer: Cofinity Commercial |
$483.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$621.97
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.42
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$587.42
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.76
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$435.38
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$55.01
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC THORACOTOMY
|
Facility
|
OP
|
$2,050.86
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$820.34 |
| Max. Negotiated Rate |
$1,845.77 |
| Rate for Payer: Aetna Commercial |
$1,743.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.06
|
| Rate for Payer: BCBS Complete |
$820.34
|
| Rate for Payer: Cash Price |
$1,640.69
|
| Rate for Payer: Cofinity Commercial |
$1,435.60
|
| Rate for Payer: Cofinity Commercial |
$1,763.74
|
| Rate for Payer: Healthscope Commercial |
$1,845.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,743.23
|
| Rate for Payer: PHP Commercial |
$1,743.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.60
|
| Rate for Payer: Priority Health SBD |
$1,292.04
|
|
|
HC THORACOTOMY
|
Facility
|
IP
|
$2,050.86
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,292.04 |
| Max. Negotiated Rate |
$1,845.77 |
| Rate for Payer: Aetna Commercial |
$1,743.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.06
|
| Rate for Payer: Cash Price |
$1,640.69
|
| Rate for Payer: Cofinity Commercial |
$1,435.60
|
| Rate for Payer: Cofinity Commercial |
$1,763.74
|
| Rate for Payer: Healthscope Commercial |
$1,845.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,743.23
|
| Rate for Payer: PHP Commercial |
$1,743.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.60
|
| Rate for Payer: Priority Health SBD |
$1,292.04
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
IP
|
$4,870.71
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,068.55 |
| Max. Negotiated Rate |
$4,383.64 |
| Rate for Payer: Aetna Commercial |
$4,140.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,165.96
|
| Rate for Payer: Cash Price |
$3,896.57
|
| Rate for Payer: Cofinity Commercial |
$3,409.50
|
| Rate for Payer: Cofinity Commercial |
$4,188.81
|
| Rate for Payer: Healthscope Commercial |
$4,383.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,140.10
|
| Rate for Payer: PHP Commercial |
$4,140.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,409.50
|
| Rate for Payer: Priority Health SBD |
$3,068.55
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
OP
|
$4,870.71
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$824.17 |
| Max. Negotiated Rate |
$4,383.64 |
| Rate for Payer: Aetna Commercial |
$4,140.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,165.96
|
| Rate for Payer: BCBS Complete |
$1,948.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,678.13
|
| Rate for Payer: Cash Price |
$3,896.57
|
| Rate for Payer: Cash Price |
$3,896.57
|
| Rate for Payer: Cofinity Commercial |
$4,188.81
|
| Rate for Payer: Cofinity Commercial |
$3,409.50
|
| Rate for Payer: Healthscope Commercial |
$4,383.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,140.10
|
| Rate for Payer: PHP Commercial |
$4,140.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,409.50
|
| Rate for Payer: Priority Health SBD |
$3,068.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$906.59
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$824.17
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$74.46
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$46.91 |
| Max. Negotiated Rate |
$67.01 |
| Rate for Payer: Aetna Commercial |
$63.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.40
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$64.04
|
| Rate for Payer: Cofinity Commercial |
$52.12
|
| Rate for Payer: Healthscope Commercial |
$67.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: PHP Commercial |
$63.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: Priority Health SBD |
$46.91
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$74.46
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$67.01 |
| Rate for Payer: Aetna Commercial |
$63.29
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.21
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$5.77
|
| Rate for Payer: BCBS Trust/PPO |
$4.52
|
| Rate for Payer: BCN Medicare Advantage |
$5.77
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$64.04
|
| Rate for Payer: Cofinity Commercial |
$52.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.77
|
| Rate for Payer: Healthscope Commercial |
$67.01
|
| Rate for Payer: Mclaren Medicaid |
$3.16
|
| Rate for Payer: Mclaren Medicare |
$5.77
|
| Rate for Payer: Meridian Medicaid |
$3.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: PACE Medicare |
$5.48
|
| Rate for Payer: PACE SWMI |
$5.77
|
| Rate for Payer: PHP Commercial |
$63.29
|
| Rate for Payer: PHP Medicare Advantage |
$5.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: Priority Health Medicare |
$5.77
|
| Rate for Payer: Priority Health SBD |
$46.91
|
| Rate for Payer: Railroad Medicare Medicare |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.92
|
| Rate for Payer: UHC Core |
$9.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.77
|
| Rate for Payer: UHC Exchange |
$5.77
|
| Rate for Payer: UHC Medicare Advantage |
$5.94
|
| Rate for Payer: VA VA |
$5.77
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
IP
|
$102.93
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$92.64 |
| Rate for Payer: Aetna Commercial |
$87.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.90
|
| Rate for Payer: Cash Price |
$82.34
|
| Rate for Payer: Cofinity Commercial |
$72.05
|
| Rate for Payer: Cofinity Commercial |
$88.52
|
| Rate for Payer: Healthscope Commercial |
$92.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.49
|
| Rate for Payer: PHP Commercial |
$87.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.05
|
| Rate for Payer: Priority Health SBD |
$64.85
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
OP
|
$102.93
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.17 |
| Max. Negotiated Rate |
$92.64 |
| Rate for Payer: Aetna Commercial |
$87.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.90
|
| Rate for Payer: BCBS Complete |
$41.17
|
| Rate for Payer: Cash Price |
$82.34
|
| Rate for Payer: Cofinity Commercial |
$72.05
|
| Rate for Payer: Cofinity Commercial |
$88.52
|
| Rate for Payer: Healthscope Commercial |
$92.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.49
|
| Rate for Payer: PHP Commercial |
$87.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.05
|
| Rate for Payer: Priority Health SBD |
$64.85
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
IP
|
$1,023.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.96 |
| Max. Negotiated Rate |
$921.38 |
| Rate for Payer: Aetna Commercial |
$870.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.44
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cofinity Commercial |
$716.62
|
| Rate for Payer: Cofinity Commercial |
$880.42
|
| Rate for Payer: Healthscope Commercial |
$921.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.19
|
| Rate for Payer: PHP Commercial |
$870.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.62
|
| Rate for Payer: Priority Health SBD |
$644.96
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
OP
|
$1,023.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$921.38 |
| Rate for Payer: Aetna Commercial |
$870.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.44
|
| Rate for Payer: BCBS Complete |
$409.50
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cofinity Commercial |
$716.62
|
| Rate for Payer: Cofinity Commercial |
$880.42
|
| Rate for Payer: Healthscope Commercial |
$921.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.19
|
| Rate for Payer: PHP Commercial |
$870.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.62
|
| Rate for Payer: Priority Health SBD |
$644.96
|
|
|
HC THROMBO EMBO CATHETER LVL 13
|
Facility
|
OP
|
$1,339.02
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.61 |
| Max. Negotiated Rate |
$1,205.12 |
| Rate for Payer: Aetna Commercial |
$1,138.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.36
|
| Rate for Payer: BCBS Complete |
$535.61
|
| Rate for Payer: Cash Price |
$1,071.22
|
| Rate for Payer: Cofinity Commercial |
$1,151.56
|
| Rate for Payer: Cofinity Commercial |
$937.31
|
| Rate for Payer: Healthscope Commercial |
$1,205.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,138.17
|
| Rate for Payer: PHP Commercial |
$1,138.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$937.31
|
| Rate for Payer: Priority Health SBD |
$843.58
|
|
|
HC THROMBO EMBO CATHETER LVL 13
|
Facility
|
IP
|
$1,339.02
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$843.58 |
| Max. Negotiated Rate |
$1,205.12 |
| Rate for Payer: Aetna Commercial |
$1,138.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.36
|
| Rate for Payer: Cash Price |
$1,071.22
|
| Rate for Payer: Cofinity Commercial |
$1,151.56
|
| Rate for Payer: Cofinity Commercial |
$937.31
|
| Rate for Payer: Healthscope Commercial |
$1,205.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,138.17
|
| Rate for Payer: PHP Commercial |
$1,138.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$937.31
|
| Rate for Payer: Priority Health SBD |
$843.58
|
|
|
HC THROMBO EMBO CATHETER LVL 14
|
Facility
|
IP
|
$1,456.71
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$917.73 |
| Max. Negotiated Rate |
$1,311.04 |
| Rate for Payer: Aetna Commercial |
$1,238.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.86
|
| Rate for Payer: Cash Price |
$1,165.37
|
| Rate for Payer: Cofinity Commercial |
$1,019.70
|
| Rate for Payer: Cofinity Commercial |
$1,252.77
|
| Rate for Payer: Healthscope Commercial |
$1,311.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,238.20
|
| Rate for Payer: PHP Commercial |
$1,238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.70
|
| Rate for Payer: Priority Health SBD |
$917.73
|
|
|
HC THROMBO EMBO CATHETER LVL 14
|
Facility
|
OP
|
$1,456.71
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.68 |
| Max. Negotiated Rate |
$1,311.04 |
| Rate for Payer: Aetna Commercial |
$1,238.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.86
|
| Rate for Payer: BCBS Complete |
$582.68
|
| Rate for Payer: Cash Price |
$1,165.37
|
| Rate for Payer: Cofinity Commercial |
$1,019.70
|
| Rate for Payer: Cofinity Commercial |
$1,252.77
|
| Rate for Payer: Healthscope Commercial |
$1,311.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,238.20
|
| Rate for Payer: PHP Commercial |
$1,238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.70
|
| Rate for Payer: Priority Health SBD |
$917.73
|
|
|
HC THROMBO EMBO CATHETER LVL 33
|
Facility
|
IP
|
$3,302.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,080.26 |
| Max. Negotiated Rate |
$2,971.80 |
| Rate for Payer: Aetna Commercial |
$2,806.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,146.30
|
| Rate for Payer: Cash Price |
$2,641.60
|
| Rate for Payer: Cofinity Commercial |
$2,311.40
|
| Rate for Payer: Cofinity Commercial |
$2,839.72
|
| Rate for Payer: Healthscope Commercial |
$2,971.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,806.70
|
| Rate for Payer: PHP Commercial |
$2,806.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.40
|
| Rate for Payer: Priority Health SBD |
$2,080.26
|
|
|
HC THROMBO EMBO CATHETER LVL 33
|
Facility
|
OP
|
$3,302.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,320.80 |
| Max. Negotiated Rate |
$2,971.80 |
| Rate for Payer: Aetna Commercial |
$2,806.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,146.30
|
| Rate for Payer: BCBS Complete |
$1,320.80
|
| Rate for Payer: Cash Price |
$2,641.60
|
| Rate for Payer: Cofinity Commercial |
$2,311.40
|
| Rate for Payer: Cofinity Commercial |
$2,839.72
|
| Rate for Payer: Healthscope Commercial |
$2,971.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,806.70
|
| Rate for Payer: PHP Commercial |
$2,806.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.40
|
| Rate for Payer: Priority Health SBD |
$2,080.26
|
|
|
HC THROMBO EMBO CATHETER LVL 46
|
Facility
|
OP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,844.00 |
| Max. Negotiated Rate |
$4,149.00 |
| Rate for Payer: Aetna Commercial |
$3,918.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,996.50
|
| Rate for Payer: BCBS Complete |
$1,844.00
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cofinity Commercial |
$3,227.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Healthscope Commercial |
$4,149.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,918.50
|
| Rate for Payer: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,227.00
|
| Rate for Payer: Priority Health SBD |
$2,904.30
|
|
|
HC THROMBO EMBO CATHETER LVL 46
|
Facility
|
IP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,904.30 |
| Max. Negotiated Rate |
$4,149.00 |
| Rate for Payer: Aetna Commercial |
$3,918.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,996.50
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cofinity Commercial |
$3,227.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Healthscope Commercial |
$4,149.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,918.50
|
| Rate for Payer: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,227.00
|
| Rate for Payer: Priority Health SBD |
$2,904.30
|
|
|
HC THROMBO EMBO CATHETER LVL 71
|
Facility
|
IP
|
$7,145.15
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,501.44 |
| Max. Negotiated Rate |
$6,430.64 |
| Rate for Payer: Aetna Commercial |
$6,073.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,644.35
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Commercial |
$5,001.60
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Healthscope Commercial |
$6,430.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,073.38
|
| Rate for Payer: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,001.60
|
| Rate for Payer: Priority Health SBD |
$4,501.44
|
|
|
HC THROMBO EMBO CATHETER LVL 71
|
Facility
|
OP
|
$7,145.15
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,858.06 |
| Max. Negotiated Rate |
$6,430.64 |
| Rate for Payer: Aetna Commercial |
$6,073.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,644.35
|
| Rate for Payer: BCBS Complete |
$2,858.06
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Commercial |
$5,001.60
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Healthscope Commercial |
$6,430.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,073.38
|
| Rate for Payer: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,001.60
|
| Rate for Payer: Priority Health SBD |
$4,501.44
|
|
