|
HC THORACENT WO TUBE
|
Facility
|
OP
|
$1,305.83
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
36100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.20 |
| Max. Negotiated Rate |
$1,697.33 |
| Rate for Payer: Aetna Commercial |
$1,109.96
|
| Rate for Payer: Aetna Medicare |
$627.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.73
|
| Rate for Payer: BCBS Complete |
$339.36
|
| Rate for Payer: BCBS MAPPO |
$602.98
|
| Rate for Payer: BCN Medicare Advantage |
$602.98
|
| Rate for Payer: Cash Price |
$1,044.66
|
| Rate for Payer: Cash Price |
$1,044.66
|
| Rate for Payer: Cofinity Commercial |
$1,123.01
|
| Rate for Payer: Cofinity Commercial |
$914.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$914.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.98
|
| Rate for Payer: Healthscope Commercial |
$1,175.25
|
| Rate for Payer: Mclaren Medicaid |
$323.20
|
| Rate for Payer: Mclaren Medicare |
$602.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.13
|
| Rate for Payer: Meridian Medicaid |
$339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.96
|
| Rate for Payer: PACE Medicare |
$572.83
|
| Rate for Payer: PACE SWMI |
$602.98
|
| Rate for Payer: PHP Commercial |
$1,109.96
|
| Rate for Payer: PHP Medicare Advantage |
$602.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.79
|
| Rate for Payer: Priority Health Medicare |
$602.98
|
| Rate for Payer: Priority Health SBD |
$822.67
|
| Rate for Payer: Railroad Medicare Medicare |
$602.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,697.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.98
|
| Rate for Payer: UHC Medicare Advantage |
$602.98
|
| Rate for Payer: UHCCP Medicaid |
$339.48
|
| Rate for Payer: VA VA |
$602.98
|
|
|
HC THORACENT WO TUBE
|
Facility
|
IP
|
$1,305.83
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
36100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.67 |
| Max. Negotiated Rate |
$1,175.25 |
| Rate for Payer: Aetna Commercial |
$1,109.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.79
|
| Rate for Payer: Cash Price |
$1,044.66
|
| Rate for Payer: Cofinity Commercial |
$1,123.01
|
| Rate for Payer: Cofinity Commercial |
$914.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$914.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.66
|
| Rate for Payer: Healthscope Commercial |
$1,175.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.96
|
| Rate for Payer: PHP Commercial |
$1,109.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.79
|
| Rate for Payer: Priority Health SBD |
$822.67
|
|
|
HC THORACENT W TUBE
|
Facility
|
IP
|
$1,414.47
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$891.12 |
| Max. Negotiated Rate |
$1,273.02 |
| Rate for Payer: Aetna Commercial |
$1,202.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.41
|
| Rate for Payer: Cash Price |
$1,131.58
|
| Rate for Payer: Cofinity Commercial |
$1,216.44
|
| Rate for Payer: Cofinity Commercial |
$990.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$990.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.58
|
| Rate for Payer: Healthscope Commercial |
$1,273.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.30
|
| Rate for Payer: PHP Commercial |
$1,202.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.41
|
| Rate for Payer: Priority Health SBD |
$891.12
|
|
|
HC THORACENT W TUBE
|
Facility
|
OP
|
$1,414.47
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$812.06 |
| Max. Negotiated Rate |
$4,264.69 |
| Rate for Payer: Aetna Commercial |
$1,202.30
|
| Rate for Payer: Aetna Medicare |
$1,575.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,893.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,893.80
|
| Rate for Payer: BCBS Complete |
$852.66
|
| Rate for Payer: BCBS MAPPO |
$1,515.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,515.04
|
| Rate for Payer: Cash Price |
$1,131.58
|
| Rate for Payer: Cash Price |
$1,131.58
|
| Rate for Payer: Cofinity Commercial |
$990.13
|
| Rate for Payer: Cofinity Commercial |
$1,216.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$990.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,515.04
|
| Rate for Payer: Healthscope Commercial |
$1,273.02
|
| Rate for Payer: Mclaren Medicaid |
$812.06
|
| Rate for Payer: Mclaren Medicare |
$1,515.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,590.79
|
| Rate for Payer: Meridian Medicaid |
$852.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,742.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.30
|
| Rate for Payer: PACE Medicare |
$1,439.29
|
| Rate for Payer: PACE SWMI |
$1,515.04
|
| Rate for Payer: PHP Commercial |
$1,202.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,515.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.41
|
| Rate for Payer: Priority Health Medicare |
$1,515.04
|
| Rate for Payer: Priority Health SBD |
$891.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,515.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,264.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,515.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,515.04
|
| Rate for Payer: UHCCP Medicaid |
$852.97
|
| Rate for Payer: VA VA |
$1,515.04
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
IP
|
$704.90
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$444.09 |
| Max. Negotiated Rate |
$634.41 |
| Rate for Payer: Aetna Commercial |
$599.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.19
|
| Rate for Payer: Cash Price |
$563.92
|
| Rate for Payer: Cofinity Commercial |
$493.43
|
| Rate for Payer: Cofinity Commercial |
$606.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$493.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.92
|
| Rate for Payer: Healthscope Commercial |
$634.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.16
|
| Rate for Payer: PHP Commercial |
$599.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.19
|
| Rate for Payer: Priority Health SBD |
$444.09
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
OP
|
$704.90
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$599.16
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$563.92
|
| Rate for Payer: Cash Price |
$563.92
|
| Rate for Payer: Cofinity Commercial |
$606.21
|
| Rate for Payer: Cofinity Commercial |
$493.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$493.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$634.41
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.16
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$599.16
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.19
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$444.09
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$521.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$521.63
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC THORACOTOMY
|
Facility
|
IP
|
$2,091.88
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,317.88 |
| Max. Negotiated Rate |
$1,882.69 |
| Rate for Payer: Aetna Commercial |
$1,778.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.72
|
| Rate for Payer: Cash Price |
$1,673.50
|
| Rate for Payer: Cofinity Commercial |
$1,464.32
|
| Rate for Payer: Cofinity Commercial |
$1,799.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,464.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,673.50
|
| Rate for Payer: Healthscope Commercial |
$1,882.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,778.10
|
| Rate for Payer: PHP Commercial |
$1,778.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.72
|
| Rate for Payer: Priority Health SBD |
$1,317.88
|
|
|
HC THORACOTOMY
|
Facility
|
OP
|
$2,091.88
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$836.75 |
| Max. Negotiated Rate |
$1,882.69 |
| Rate for Payer: Aetna Commercial |
$1,778.10
|
| Rate for Payer: Aetna Medicare |
$1,045.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.72
|
| Rate for Payer: BCBS Complete |
$836.75
|
| Rate for Payer: Cash Price |
$1,673.50
|
| Rate for Payer: Cofinity Commercial |
$1,464.32
|
| Rate for Payer: Cofinity Commercial |
$1,799.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,464.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,673.50
|
| Rate for Payer: Healthscope Commercial |
$1,882.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,778.10
|
| Rate for Payer: PHP Commercial |
$1,778.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.72
|
| Rate for Payer: Priority Health SBD |
$1,317.88
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
IP
|
$4,968.12
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,129.92 |
| Max. Negotiated Rate |
$4,471.31 |
| Rate for Payer: Aetna Commercial |
$4,222.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,229.28
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cofinity Commercial |
$3,477.68
|
| Rate for Payer: Cofinity Commercial |
$4,272.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,477.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,974.50
|
| Rate for Payer: Healthscope Commercial |
$4,471.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,222.90
|
| Rate for Payer: PHP Commercial |
$4,222.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.28
|
| Rate for Payer: Priority Health SBD |
$3,129.92
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
OP
|
$4,968.12
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,987.25 |
| Max. Negotiated Rate |
$4,471.31 |
| Rate for Payer: Aetna Commercial |
$4,222.90
|
| Rate for Payer: Aetna Medicare |
$2,484.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,229.28
|
| Rate for Payer: BCBS Complete |
$1,987.25
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cofinity Commercial |
$3,477.68
|
| Rate for Payer: Cofinity Commercial |
$4,272.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,477.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,974.50
|
| Rate for Payer: Healthscope Commercial |
$4,471.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,222.90
|
| Rate for Payer: PHP Commercial |
$4,222.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.28
|
| Rate for Payer: Priority Health SBD |
$3,129.92
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.37
|
| 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 |
$3.25
|
| Rate for Payer: BCBS MAPPO |
$5.77
|
| Rate for Payer: BCN Medicare Advantage |
$5.77
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Cofinity Commercial |
$53.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.77
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| 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 |
$3.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: PACE Medicare |
$5.48
|
| Rate for Payer: PACE SWMI |
$5.77
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: PHP Medicare Advantage |
$5.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health Medicare |
$5.77
|
| Rate for Payer: Priority Health SBD |
$47.85
|
| Rate for Payer: Railroad Medicare Medicare |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.77
|
| Rate for Payer: UHC Medicare Advantage |
$5.77
|
| Rate for Payer: UHCCP Medicaid |
$3.25
|
| Rate for Payer: VA VA |
$5.77
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.85 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.37
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$53.16
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health SBD |
$47.85
|
|
|
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 Commercial |
$73.49
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.49
|
| 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: PHP Commercial |
$89.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.24
|
| Rate for Payer: Priority Health SBD |
$66.14
|
|
|
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 |
$42.00 |
| 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 Commercial |
$73.49
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.49
|
| 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: PHP Commercial |
$89.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.24
|
| Rate for Payer: Priority Health SBD |
$66.14
|
|
|
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 |
$417.69 |
| 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 Commercial |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$730.96
|
| 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: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.75
|
| Rate for Payer: Priority Health SBD |
$657.86
|
|
|
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 Commercial |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$730.96
|
| 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: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.75
|
| Rate for Payer: Priority Health SBD |
$657.86
|
|
|
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 |
$546.32 |
| 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 Commercial |
$1,174.59
|
| Rate for Payer: Cofinity Commercial |
$956.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$956.06
|
| 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: PHP Commercial |
$1,160.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$887.77
|
| Rate for Payer: Priority Health SBD |
$860.45
|
|
|
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 Commercial |
$1,174.59
|
| Rate for Payer: Cofinity Commercial |
$956.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$956.06
|
| 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: PHP Commercial |
$1,160.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$887.77
|
| Rate for Payer: Priority Health SBD |
$860.45
|
|
|
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 Commercial |
$1,040.09
|
| Rate for Payer: Cofinity Commercial |
$1,277.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,040.09
|
| 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: PHP Commercial |
$1,262.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$965.80
|
| Rate for Payer: Priority Health SBD |
$936.08
|
|
|
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 |
$594.34 |
| 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 Commercial |
$1,040.09
|
| Rate for Payer: Cofinity Commercial |
$1,277.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,040.09
|
| 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: PHP Commercial |
$1,262.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$965.80
|
| 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 |
$1,347.22 |
| 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 Commercial |
$2,357.63
|
| Rate for Payer: Cofinity Commercial |
$2,896.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,357.63
|
| 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: PHP Commercial |
$2,862.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.23
|
| Rate for Payer: Priority Health SBD |
$2,121.87
|
|
|
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 Commercial |
$2,357.63
|
| Rate for Payer: Cofinity Commercial |
$2,896.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,357.63
|
| 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: PHP Commercial |
$2,862.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.23
|
| 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 |
$1,844.00 |
| 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 Commercial |
$3,227.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,227.00
|
| 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: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,996.50
|
| 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: Cofinity Medicare Advantage |
$3,227.00
|
| 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: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,996.50
|
| 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 Commercial |
$5,001.60
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,001.60
|
| 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: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,644.35
|
| Rate for Payer: Priority Health SBD |
$4,501.44
|
|
