|
HC THROMBIN TIME
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: Priority Health SBD |
$48.81
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$77.47
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| 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 |
$3.17
|
| Rate for Payer: BCBS MAPPO |
$5.77
|
| Rate for Payer: BCBS Trust/PPO |
$6.16
|
| Rate for Payer: BCN Commercial |
$6.16
|
| Rate for Payer: BCN Medicare Advantage |
$5.77
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.77
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Mclaren Medicaid |
$3.02
|
| Rate for Payer: Mclaren Medicare |
$5.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.06
|
| Rate for Payer: Meridian Medicaid |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$8.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PACE Medicare |
$5.48
|
| Rate for Payer: PACE SWMI |
$5.77
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: PHP Medicare Advantage |
$5.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.77
|
| Rate for Payer: Priority Health Medicare |
$5.77
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: Priority Health Tiered Network |
$4.62
|
| Rate for Payer: Railroad Medicare Medicare |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.66
|
| Rate for Payer: UHC Core |
$8.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.77
|
| Rate for Payer: UHC Exchange |
$8.66
|
| Rate for Payer: UHC Medicaid |
$3.02
|
| Rate for Payer: UHCCP Medicaid |
$3.02
|
| Rate for Payer: VA VA |
$5.77
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
OP
|
$104.99
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.26 |
| Max. Negotiated Rate |
$94.49 |
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: Aetna Medicare |
$52.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.24
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Cofinity Advantage |
$73.49
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.74
|
| Rate for Payer: PHP Commercial |
$89.24
|
| Rate for Payer: Priority Health SBD |
$66.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.24
|
| Rate for Payer: UHC Core |
$54.70
|
| Rate for Payer: UHC Exchange |
$41.26
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
IP
|
$104.99
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.14 |
| Max. Negotiated Rate |
$94.49 |
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.24
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Cofinity Advantage |
$73.49
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$94.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.74
|
| Rate for Payer: PHP Commercial |
$89.24
|
| Rate for Payer: Priority Health SBD |
$66.14
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
IP
|
$1,044.23
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$657.86 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.75
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Advantage |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.17
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health SBD |
$657.86
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
OP
|
$1,044.23
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.38 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna Medicare |
$522.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.75
|
| Rate for Payer: BCBS Complete |
$417.69
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Advantage |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$835.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.17
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health SBD |
$657.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.75
|
| Rate for Payer: UHC Core |
$544.04
|
| Rate for Payer: UHC Exchange |
$410.38
|
|
|
HC THROMBO EMBO CATHETER LVL 13
|
Facility
|
IP
|
$1,365.80
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$860.45 |
| Max. Negotiated Rate |
$1,229.22 |
| Rate for Payer: Aetna Commercial |
$1,160.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.77
|
| Rate for Payer: Cash Price |
$1,092.64
|
| Rate for Payer: Cofinity Advantage |
$956.06
|
| Rate for Payer: Cofinity Commercial |
$1,174.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,092.64
|
| Rate for Payer: Healthscope Commercial |
$1,229.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,160.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,024.35
|
| Rate for Payer: PHP Commercial |
$1,160.93
|
| Rate for Payer: Priority Health SBD |
$860.45
|
|
|
HC THROMBO EMBO CATHETER LVL 13
|
Facility
|
OP
|
$1,365.80
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$1,229.22 |
| Rate for Payer: Aetna Commercial |
$1,160.93
|
| Rate for Payer: Aetna Medicare |
$682.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.77
|
| Rate for Payer: BCBS Complete |
$546.32
|
| Rate for Payer: Cash Price |
$1,092.64
|
| Rate for Payer: Cofinity Advantage |
$956.06
|
| Rate for Payer: Cofinity Commercial |
$1,174.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,092.64
|
| Rate for Payer: Healthscope Commercial |
$1,229.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,092.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,160.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,024.35
|
| Rate for Payer: PHP Commercial |
$1,160.93
|
| Rate for Payer: Priority Health SBD |
$860.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$887.77
|
| Rate for Payer: UHC Core |
$711.58
|
| Rate for Payer: UHC Exchange |
$536.76
|
|
|
HC THROMBO EMBO CATHETER LVL 14
|
Facility
|
OP
|
$1,485.84
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.94 |
| Max. Negotiated Rate |
$1,337.26 |
| Rate for Payer: Aetna Commercial |
$1,262.96
|
| Rate for Payer: Aetna Medicare |
$742.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$965.80
|
| Rate for Payer: BCBS Complete |
$594.34
|
| Rate for Payer: Cash Price |
$1,188.67
|
| Rate for Payer: Cofinity Advantage |
$1,040.09
|
| Rate for Payer: Cofinity Commercial |
$1,277.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,188.67
|
| Rate for Payer: Healthscope Commercial |
$1,337.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,188.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,114.38
|
| Rate for Payer: PHP Commercial |
$1,262.96
|
| Rate for Payer: Priority Health SBD |
$936.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$965.80
|
| Rate for Payer: UHC Core |
$774.12
|
| Rate for Payer: UHC Exchange |
$583.94
|
|
|
HC THROMBO EMBO CATHETER LVL 14
|
Facility
|
IP
|
$1,485.84
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$936.08 |
| Max. Negotiated Rate |
$1,337.26 |
| Rate for Payer: Aetna Commercial |
$1,262.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$965.80
|
| Rate for Payer: Cash Price |
$1,188.67
|
| Rate for Payer: Cofinity Advantage |
$1,040.09
|
| Rate for Payer: Cofinity Commercial |
$1,277.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,188.67
|
| Rate for Payer: Healthscope Commercial |
$1,337.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,114.38
|
| Rate for Payer: PHP Commercial |
$1,262.96
|
| Rate for Payer: Priority Health SBD |
$936.08
|
|
|
HC THROMBO EMBO CATHETER LVL 33
|
Facility
|
OP
|
$3,368.04
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,323.64 |
| Max. Negotiated Rate |
$3,031.24 |
| Rate for Payer: Aetna Commercial |
$2,862.83
|
| Rate for Payer: Aetna Medicare |
$1,684.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,189.23
|
| Rate for Payer: BCBS Complete |
$1,347.22
|
| Rate for Payer: Cash Price |
$2,694.43
|
| Rate for Payer: Cofinity Advantage |
$2,357.63
|
| Rate for Payer: Cofinity Commercial |
$2,896.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,694.43
|
| Rate for Payer: Healthscope Commercial |
$3,031.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,694.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,862.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,526.03
|
| Rate for Payer: PHP Commercial |
$2,862.83
|
| Rate for Payer: Priority Health SBD |
$2,121.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,189.23
|
| Rate for Payer: UHC Core |
$1,754.75
|
| Rate for Payer: UHC Exchange |
$1,323.64
|
|
|
HC THROMBO EMBO CATHETER LVL 33
|
Facility
|
IP
|
$3,368.04
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,121.87 |
| Max. Negotiated Rate |
$3,031.24 |
| Rate for Payer: Aetna Commercial |
$2,862.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,189.23
|
| Rate for Payer: Cash Price |
$2,694.43
|
| Rate for Payer: Cofinity Advantage |
$2,357.63
|
| Rate for Payer: Cofinity Commercial |
$2,896.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,694.43
|
| Rate for Payer: Healthscope Commercial |
$3,031.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,862.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,526.03
|
| Rate for Payer: PHP Commercial |
$2,862.83
|
| Rate for Payer: Priority Health SBD |
$2,121.87
|
|
|
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 |
$1,811.73 |
| Max. Negotiated Rate |
$4,149.00 |
| Rate for Payer: Aetna Commercial |
$3,918.50
|
| Rate for Payer: Aetna Medicare |
$2,305.00
|
| 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 Advantage |
$3,227.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,688.00
|
| Rate for Payer: Healthscope Commercial |
$4,149.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,688.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,918.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,457.50
|
| Rate for Payer: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health SBD |
$2,904.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,996.50
|
| Rate for Payer: UHC Core |
$2,401.81
|
| Rate for Payer: UHC Exchange |
$1,811.73
|
|
|
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 Advantage |
$3,227.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,688.00
|
| Rate for Payer: Healthscope Commercial |
$4,149.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,918.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,457.50
|
| Rate for Payer: PHP Commercial |
$3,918.50
|
| 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 Advantage |
$5,001.60
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Healthscope Commercial |
$6,430.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,073.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,358.86
|
| Rate for Payer: PHP Commercial |
$6,073.38
|
| 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 |
$2,808.04 |
| Max. Negotiated Rate |
$6,430.64 |
| Rate for Payer: Aetna Commercial |
$6,073.38
|
| Rate for Payer: Aetna Medicare |
$3,572.57
|
| 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 Advantage |
$5,001.60
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Healthscope Commercial |
$6,430.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,716.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,073.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,358.86
|
| Rate for Payer: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health SBD |
$4,501.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,644.35
|
| Rate for Payer: UHC Core |
$3,722.62
|
| Rate for Payer: UHC Exchange |
$2,808.04
|
|
|
HC THROMBO EMBO CATHETER LVL 88
|
Facility
|
OP
|
$8,810.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,462.33 |
| Max. Negotiated Rate |
$7,929.00 |
| Rate for Payer: Aetna Commercial |
$7,488.50
|
| Rate for Payer: Aetna Medicare |
$4,405.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,726.50
|
| Rate for Payer: BCBS Complete |
$3,524.00
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Advantage |
$6,167.00
|
| Rate for Payer: Cofinity Commercial |
$7,576.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,048.00
|
| Rate for Payer: Healthscope Commercial |
$7,929.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,048.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,607.50
|
| Rate for Payer: PHP Commercial |
$7,488.50
|
| Rate for Payer: Priority Health SBD |
$5,550.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,726.50
|
| Rate for Payer: UHC Core |
$4,590.01
|
| Rate for Payer: UHC Exchange |
$3,462.33
|
|
|
HC THROMBO EMBO CATHETER LVL 88
|
Facility
|
IP
|
$8,810.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,550.30 |
| Max. Negotiated Rate |
$7,929.00 |
| Rate for Payer: Aetna Commercial |
$7,488.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,726.50
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Advantage |
$6,167.00
|
| Rate for Payer: Cofinity Commercial |
$7,576.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,048.00
|
| Rate for Payer: Healthscope Commercial |
$7,929.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,607.50
|
| Rate for Payer: PHP Commercial |
$7,488.50
|
| Rate for Payer: Priority Health SBD |
$5,550.30
|
|
|
HC THROMBO EMBO LVL 141
|
Facility
|
OP
|
$14,159.85
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
27200225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,564.82 |
| Max. Negotiated Rate |
$12,743.86 |
| Rate for Payer: Aetna Commercial |
$12,035.87
|
| Rate for Payer: Aetna Medicare |
$7,079.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,203.90
|
| Rate for Payer: BCBS Complete |
$5,663.94
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Advantage |
$9,911.90
|
| Rate for Payer: Cofinity Commercial |
$12,177.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Healthscope Commercial |
$12,743.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,327.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,035.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,619.89
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: Priority Health SBD |
$8,920.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,203.90
|
| Rate for Payer: UHC Core |
$7,377.28
|
| Rate for Payer: UHC Exchange |
$5,564.82
|
|
|
HC THROMBO EMBO LVL 141
|
Facility
|
IP
|
$14,159.85
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
27200225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,920.71 |
| Max. Negotiated Rate |
$12,743.86 |
| Rate for Payer: Aetna Commercial |
$12,035.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,203.90
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Advantage |
$9,911.90
|
| Rate for Payer: Cofinity Commercial |
$12,177.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Healthscope Commercial |
$12,743.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,035.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,619.89
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: Priority Health SBD |
$8,920.71
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
OP
|
$530.20
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$1,064.33 |
| Rate for Payer: Aetna Commercial |
$450.67
|
| Rate for Payer: Aetna Medicare |
$342.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$191.87
|
| Rate for Payer: BCN Commercial |
$191.87
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$424.16
|
| Rate for Payer: Cash Price |
$424.16
|
| Rate for Payer: Cash Price |
$424.16
|
| Rate for Payer: Cofinity Advantage |
$371.14
|
| Rate for Payer: Cofinity Commercial |
$455.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$477.18
|
| Rate for Payer: Mclaren Medicaid |
$172.13
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$345.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.67
|
| Rate for Payer: Nomi Health Commercial |
$987.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.65
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$450.67
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,064.33
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health SBD |
$334.03
|
| Rate for Payer: Priority Health Tiered Network |
$851.46
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
IP
|
$530.20
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$334.03 |
| Max. Negotiated Rate |
$477.18 |
| Rate for Payer: Aetna Commercial |
$450.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.63
|
| Rate for Payer: Cash Price |
$424.16
|
| Rate for Payer: Cofinity Advantage |
$371.14
|
| Rate for Payer: Cofinity Commercial |
$455.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.16
|
| Rate for Payer: Healthscope Commercial |
$477.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.65
|
| Rate for Payer: PHP Commercial |
$450.67
|
| Rate for Payer: Priority Health SBD |
$334.03
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
OP
|
$4,737.42
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$469.70 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$4,026.81
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,079.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$469.70
|
| Rate for Payer: BCN Commercial |
$469.70
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,789.94
|
| Rate for Payer: Cash Price |
$3,789.94
|
| Rate for Payer: Cash Price |
$3,789.94
|
| Rate for Payer: Cofinity Advantage |
$3,316.19
|
| Rate for Payer: Cofinity Commercial |
$4,074.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,789.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$4,263.68
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,026.81
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,553.07
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$4,026.81
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,984.57
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
IP
|
$4,737.42
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,984.57 |
| Max. Negotiated Rate |
$4,263.68 |
| Rate for Payer: Aetna Commercial |
$4,026.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,079.32
|
| Rate for Payer: Cash Price |
$3,789.94
|
| Rate for Payer: Cofinity Advantage |
$3,316.19
|
| Rate for Payer: Cofinity Commercial |
$4,074.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,789.94
|
| Rate for Payer: Healthscope Commercial |
$4,263.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,026.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,553.07
|
| Rate for Payer: PHP Commercial |
$4,026.81
|
| Rate for Payer: Priority Health SBD |
$2,984.57
|
|
|
HC THSD7
|
Facility
|
OP
|
$387.97
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$349.17 |
| Rate for Payer: Aetna Commercial |
$329.77
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$310.38
|
| Rate for Payer: Cash Price |
$310.38
|
| Rate for Payer: Cofinity Advantage |
$271.58
|
| Rate for Payer: Cofinity Commercial |
$333.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$349.17
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.77
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.98
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$329.77
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$244.42
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
