|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
OP
|
$5,067.48
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$893.40 |
| Max. Negotiated Rate |
$4,560.73 |
| Rate for Payer: Aetna Commercial |
$4,307.36
|
| Rate for Payer: Aetna Medicare |
$1,317.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,583.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,583.59
|
| Rate for Payer: BCBS Complete |
$937.99
|
| Rate for Payer: BCBS MAPPO |
$1,266.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,165.98
|
| Rate for Payer: BCN Commercial |
$4,165.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,266.87
|
| Rate for Payer: Cash Price |
$4,053.98
|
| Rate for Payer: Cofinity Commercial |
$4,358.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,053.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,266.87
|
| Rate for Payer: Healthscope Commercial |
$4,560.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,800.61
|
| Rate for Payer: Mclaren Medicaid |
$893.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,330.21
|
| Rate for Payer: Meridian Medicaid |
$937.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,456.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,393.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,307.36
|
| Rate for Payer: Nomi Health Commercial |
$4,155.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,800.61
|
| Rate for Payer: PACE Senior Care Partners |
$1,203.53
|
| Rate for Payer: PACE SWMI |
$1,266.87
|
| Rate for Payer: PHP Commercial |
$4,307.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,266.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$893.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,408.71
|
| Rate for Payer: Priority Health Medicare |
$1,279.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,526.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,266.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,459.38
|
| Rate for Payer: UHC Core |
$4,231.35
|
| Rate for Payer: UHC Exchange |
$1,266.87
|
| Rate for Payer: UHC Medicaid |
$893.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,266.87
|
| Rate for Payer: UHCCP Medicaid |
$893.40
|
| Rate for Payer: VA VA |
$1,266.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,800.61
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$53.92 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: BCBS Trust/PPO |
$63.98
|
| Rate for Payer: BCN Commercial |
$63.98
|
| Rate for Payer: Cash Price |
$61.98
|
| 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: Lakeland Regional Health Systems Commercial |
$58.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.17
|
| Rate for Payer: UHC Core |
$64.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.10
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$77.47
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna Medicare |
$20.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.21
|
| Rate for Payer: BCBS Complete |
$14.34
|
| Rate for Payer: BCBS MAPPO |
$19.37
|
| Rate for Payer: BCBS Trust/PPO |
$63.69
|
| Rate for Payer: BCN Commercial |
$63.69
|
| Rate for Payer: BCN Medicare Advantage |
$19.37
|
| Rate for Payer: Cash Price |
$61.98
|
| 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 |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.10
|
| Rate for Payer: Mclaren Medicaid |
$13.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.34
|
| Rate for Payer: Meridian Medicaid |
$14.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PACE Senior Care Partners |
$18.40
|
| Rate for Payer: PACE SWMI |
$19.37
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: PHP Medicare Advantage |
$19.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.40
|
| Rate for Payer: Priority Health Medicare |
$19.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.92
|
| Rate for Payer: Railroad Medicare Medicare |
$19.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.17
|
| Rate for Payer: UHC Core |
$64.69
|
| Rate for Payer: UHC Exchange |
$19.37
|
| Rate for Payer: UHC Medicaid |
$13.66
|
| Rate for Payer: UHC Medicare Advantage |
$19.37
|
| Rate for Payer: UHCCP Medicaid |
$13.66
|
| Rate for Payer: VA VA |
$19.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.10
|
|
|
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 |
$18.51 |
| Max. Negotiated Rate |
$94.49 |
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: Aetna Medicare |
$27.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.81
|
| Rate for Payer: BCBS Complete |
$19.43
|
| Rate for Payer: BCBS MAPPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$86.31
|
| Rate for Payer: BCN Commercial |
$86.31
|
| Rate for Payer: BCN Medicare Advantage |
$26.25
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.25
|
| Rate for Payer: Healthscope Commercial |
$94.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.74
|
| Rate for Payer: Mclaren Medicaid |
$18.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.56
|
| Rate for Payer: Meridian Medicaid |
$19.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.24
|
| Rate for Payer: Nomi Health Commercial |
$86.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.74
|
| Rate for Payer: PACE Senior Care Partners |
$24.94
|
| Rate for Payer: PACE SWMI |
$26.25
|
| Rate for Payer: PHP Commercial |
$89.24
|
| Rate for Payer: PHP Medicare Advantage |
$26.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.34
|
| Rate for Payer: Priority Health Medicare |
$26.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.07
|
| Rate for Payer: Railroad Medicare Medicare |
$26.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.39
|
| Rate for Payer: UHC Core |
$87.67
|
| Rate for Payer: UHC Exchange |
$26.25
|
| Rate for Payer: UHC Medicaid |
$18.51
|
| Rate for Payer: UHC Medicare Advantage |
$26.25
|
| Rate for Payer: UHCCP Medicaid |
$18.51
|
| Rate for Payer: VA VA |
$26.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.74
|
|
|
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 |
$73.07 |
| Max. Negotiated Rate |
$94.49 |
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: BCBS Trust/PPO |
$86.71
|
| Rate for Payer: BCN Commercial |
$86.71
|
| Rate for Payer: Cash Price |
$83.99
|
| 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: Lakeland Regional Health Systems Commercial |
$78.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.24
|
| Rate for Payer: Nomi Health Commercial |
$86.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.74
|
| Rate for Payer: PHP Commercial |
$89.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.39
|
| Rate for Payer: UHC Core |
$87.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.74
|
|
|
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 |
$184.10 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna Medicare |
$271.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$326.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$326.32
|
| Rate for Payer: BCBS Complete |
$193.29
|
| Rate for Payer: BCBS MAPPO |
$261.06
|
| Rate for Payer: BCBS Trust/PPO |
$858.46
|
| Rate for Payer: BCN Commercial |
$858.46
|
| Rate for Payer: BCN Medicare Advantage |
$261.06
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$261.06
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: Mclaren Medicaid |
$184.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$274.11
|
| Rate for Payer: Meridian Medicaid |
$193.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$287.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Nomi Health Commercial |
$856.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.17
|
| Rate for Payer: PACE Senior Care Partners |
$248.00
|
| Rate for Payer: PACE SWMI |
$261.06
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: PHP Medicare Advantage |
$261.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$908.48
|
| Rate for Payer: Priority Health Medicare |
$263.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$726.78
|
| Rate for Payer: Railroad Medicare Medicare |
$261.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$918.92
|
| Rate for Payer: UHC Core |
$871.93
|
| Rate for Payer: UHC Exchange |
$261.06
|
| Rate for Payer: UHC Medicaid |
$184.10
|
| Rate for Payer: UHC Medicare Advantage |
$261.06
|
| Rate for Payer: UHCCP Medicaid |
$184.10
|
| Rate for Payer: VA VA |
$261.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
|
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 |
$726.78 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: BCBS Trust/PPO |
$862.43
|
| Rate for Payer: BCN Commercial |
$862.43
|
| Rate for Payer: Cash Price |
$835.38
|
| 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: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Nomi Health Commercial |
$856.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.17
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$908.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$726.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$918.92
|
| Rate for Payer: UHC Core |
$871.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
|
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 |
$240.79 |
| Max. Negotiated Rate |
$1,229.22 |
| Rate for Payer: Aetna Commercial |
$1,160.93
|
| Rate for Payer: Aetna Medicare |
$355.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$426.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$426.81
|
| Rate for Payer: BCBS Complete |
$252.81
|
| Rate for Payer: BCBS MAPPO |
$341.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.82
|
| Rate for Payer: BCN Commercial |
$1,122.82
|
| Rate for Payer: BCN Medicare Advantage |
$341.45
|
| Rate for Payer: Cash Price |
$1,092.64
|
| Rate for Payer: Cofinity Commercial |
$1,174.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,092.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.45
|
| Rate for Payer: Healthscope Commercial |
$1,229.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,024.35
|
| Rate for Payer: Mclaren Medicaid |
$240.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$358.52
|
| Rate for Payer: Meridian Medicaid |
$252.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$392.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$375.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,160.93
|
| Rate for Payer: Nomi Health Commercial |
$1,119.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,024.35
|
| Rate for Payer: PACE Senior Care Partners |
$324.38
|
| Rate for Payer: PACE SWMI |
$341.45
|
| Rate for Payer: PHP Commercial |
$1,160.93
|
| Rate for Payer: PHP Medicare Advantage |
$341.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,188.25
|
| Rate for Payer: Priority Health Medicare |
$344.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$950.60
|
| Rate for Payer: Railroad Medicare Medicare |
$341.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,201.90
|
| Rate for Payer: UHC Core |
$1,140.44
|
| Rate for Payer: UHC Exchange |
$341.45
|
| Rate for Payer: UHC Medicaid |
$240.79
|
| Rate for Payer: UHC Medicare Advantage |
$341.45
|
| Rate for Payer: UHCCP Medicaid |
$240.79
|
| Rate for Payer: VA VA |
$341.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,024.35
|
|
|
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 |
$950.60 |
| Max. Negotiated Rate |
$1,229.22 |
| Rate for Payer: Aetna Commercial |
$1,160.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.01
|
| Rate for Payer: BCN Commercial |
$1,128.01
|
| Rate for Payer: Cash Price |
$1,092.64
|
| 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: Lakeland Regional Health Systems Commercial |
$1,024.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,160.93
|
| Rate for Payer: Nomi Health Commercial |
$1,119.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,024.35
|
| Rate for Payer: PHP Commercial |
$1,160.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,188.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$950.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,201.90
|
| Rate for Payer: UHC Core |
$1,140.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,024.35
|
|
|
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 |
$1,034.14 |
| Max. Negotiated Rate |
$1,337.26 |
| Rate for Payer: Aetna Commercial |
$1,262.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,227.16
|
| Rate for Payer: BCN Commercial |
$1,227.16
|
| Rate for Payer: Cash Price |
$1,188.67
|
| 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: Lakeland Regional Health Systems Commercial |
$1,114.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.96
|
| Rate for Payer: Nomi Health Commercial |
$1,218.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,114.38
|
| Rate for Payer: PHP Commercial |
$1,262.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,292.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,034.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,307.54
|
| Rate for Payer: UHC Core |
$1,240.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,114.38
|
|
|
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 |
$261.95 |
| Max. Negotiated Rate |
$1,337.26 |
| Rate for Payer: Aetna Commercial |
$1,262.96
|
| Rate for Payer: Aetna Medicare |
$386.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.32
|
| Rate for Payer: BCBS Complete |
$275.03
|
| Rate for Payer: BCBS MAPPO |
$371.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.51
|
| Rate for Payer: BCN Commercial |
$1,221.51
|
| Rate for Payer: BCN Medicare Advantage |
$371.46
|
| Rate for Payer: Cash Price |
$1,188.67
|
| Rate for Payer: Cofinity Commercial |
$1,277.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,188.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.46
|
| Rate for Payer: Healthscope Commercial |
$1,337.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,114.38
|
| Rate for Payer: Mclaren Medicaid |
$261.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.03
|
| Rate for Payer: Meridian Medicaid |
$275.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$408.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.96
|
| Rate for Payer: Nomi Health Commercial |
$1,218.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,114.38
|
| Rate for Payer: PACE Senior Care Partners |
$352.89
|
| Rate for Payer: PACE SWMI |
$371.46
|
| Rate for Payer: PHP Commercial |
$1,262.96
|
| Rate for Payer: PHP Medicare Advantage |
$371.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,292.68
|
| Rate for Payer: Priority Health Medicare |
$375.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,034.14
|
| Rate for Payer: Railroad Medicare Medicare |
$371.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,307.54
|
| Rate for Payer: UHC Core |
$1,240.68
|
| Rate for Payer: UHC Exchange |
$371.46
|
| Rate for Payer: UHC Medicaid |
$261.95
|
| Rate for Payer: UHC Medicare Advantage |
$371.46
|
| Rate for Payer: UHCCP Medicaid |
$261.95
|
| Rate for Payer: VA VA |
$371.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,114.38
|
|
|
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 |
$2,344.16 |
| Max. Negotiated Rate |
$3,031.24 |
| Rate for Payer: Aetna Commercial |
$2,862.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,781.66
|
| Rate for Payer: BCN Commercial |
$2,781.66
|
| Rate for Payer: Cash Price |
$2,694.43
|
| 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: Lakeland Regional Health Systems Commercial |
$2,526.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,862.83
|
| Rate for Payer: Nomi Health Commercial |
$2,761.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,526.03
|
| Rate for Payer: PHP Commercial |
$2,862.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,930.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,344.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,963.88
|
| Rate for Payer: UHC Core |
$2,812.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,526.03
|
|
|
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 |
$593.79 |
| Max. Negotiated Rate |
$3,031.24 |
| Rate for Payer: Aetna Commercial |
$2,862.83
|
| Rate for Payer: Aetna Medicare |
$875.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,052.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,052.51
|
| Rate for Payer: BCBS Complete |
$623.42
|
| Rate for Payer: BCBS MAPPO |
$842.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,768.87
|
| Rate for Payer: BCN Commercial |
$2,768.87
|
| Rate for Payer: BCN Medicare Advantage |
$842.01
|
| Rate for Payer: Cash Price |
$2,694.43
|
| Rate for Payer: Cofinity Commercial |
$2,896.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,694.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$842.01
|
| Rate for Payer: Healthscope Commercial |
$3,031.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,526.03
|
| Rate for Payer: Mclaren Medicaid |
$593.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$884.11
|
| Rate for Payer: Meridian Medicaid |
$623.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$968.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$926.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,862.83
|
| Rate for Payer: Nomi Health Commercial |
$2,761.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,526.03
|
| Rate for Payer: PACE Senior Care Partners |
$799.91
|
| Rate for Payer: PACE SWMI |
$842.01
|
| Rate for Payer: PHP Commercial |
$2,862.83
|
| Rate for Payer: PHP Medicare Advantage |
$842.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$593.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,930.19
|
| Rate for Payer: Priority Health Medicare |
$850.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,344.16
|
| Rate for Payer: Railroad Medicare Medicare |
$842.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,963.88
|
| Rate for Payer: UHC Core |
$2,812.31
|
| Rate for Payer: UHC Exchange |
$842.01
|
| Rate for Payer: UHC Medicaid |
$593.79
|
| Rate for Payer: UHC Medicare Advantage |
$842.01
|
| Rate for Payer: UHCCP Medicaid |
$593.79
|
| Rate for Payer: VA VA |
$842.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,526.03
|
|
|
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 |
$812.74 |
| Max. Negotiated Rate |
$4,149.00 |
| Rate for Payer: Aetna Commercial |
$3,918.50
|
| Rate for Payer: Aetna Medicare |
$1,198.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,440.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,440.62
|
| Rate for Payer: BCBS Complete |
$853.31
|
| Rate for Payer: BCBS MAPPO |
$1,152.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,789.88
|
| Rate for Payer: BCN Commercial |
$3,789.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,152.50
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,688.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,152.50
|
| Rate for Payer: Healthscope Commercial |
$4,149.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,457.50
|
| Rate for Payer: Mclaren Medicaid |
$812.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,210.12
|
| Rate for Payer: Meridian Medicaid |
$853.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,325.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,267.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,918.50
|
| Rate for Payer: Nomi Health Commercial |
$3,780.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,457.50
|
| Rate for Payer: PACE Senior Care Partners |
$1,094.88
|
| Rate for Payer: PACE SWMI |
$1,152.50
|
| Rate for Payer: PHP Commercial |
$3,918.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,152.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,010.70
|
| Rate for Payer: Priority Health Medicare |
$1,164.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,208.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,152.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,056.80
|
| Rate for Payer: UHC Core |
$3,849.35
|
| Rate for Payer: UHC Exchange |
$1,152.50
|
| Rate for Payer: UHC Medicaid |
$812.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,152.50
|
| Rate for Payer: UHCCP Medicaid |
$812.74
|
| Rate for Payer: VA VA |
$1,152.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,457.50
|
|
|
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 |
$3,208.56 |
| Max. Negotiated Rate |
$4,149.00 |
| Rate for Payer: Aetna Commercial |
$3,918.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,807.40
|
| Rate for Payer: BCN Commercial |
$3,807.40
|
| Rate for Payer: Cash Price |
$3,688.00
|
| 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: Lakeland Regional Health Systems Commercial |
$3,457.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,918.50
|
| Rate for Payer: Nomi Health Commercial |
$3,780.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,457.50
|
| Rate for Payer: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,010.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,208.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,056.80
|
| Rate for Payer: UHC Core |
$3,849.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,457.50
|
|
|
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 |
$4,973.02 |
| Max. Negotiated Rate |
$6,430.64 |
| Rate for Payer: Aetna Commercial |
$6,073.38
|
| Rate for Payer: BCBS Trust/PPO |
$5,901.18
|
| Rate for Payer: BCN Commercial |
$5,901.18
|
| Rate for Payer: Cash Price |
$5,716.12
|
| 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: Lakeland Regional Health Systems Commercial |
$5,358.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,073.38
|
| Rate for Payer: Nomi Health Commercial |
$5,859.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,358.86
|
| Rate for Payer: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,216.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,973.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,287.73
|
| Rate for Payer: UHC Core |
$5,966.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,358.86
|
|
|
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 |
$1,259.69 |
| Max. Negotiated Rate |
$6,430.64 |
| Rate for Payer: Aetna Commercial |
$6,073.38
|
| Rate for Payer: Aetna Medicare |
$1,857.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,232.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,232.86
|
| Rate for Payer: BCBS Complete |
$1,322.57
|
| Rate for Payer: BCBS MAPPO |
$1,786.29
|
| Rate for Payer: BCBS Trust/PPO |
$5,874.03
|
| Rate for Payer: BCN Commercial |
$5,874.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,786.29
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,786.29
|
| Rate for Payer: Healthscope Commercial |
$6,430.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,358.86
|
| Rate for Payer: Mclaren Medicaid |
$1,259.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,875.60
|
| Rate for Payer: Meridian Medicaid |
$1,322.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,054.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,964.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,073.38
|
| Rate for Payer: Nomi Health Commercial |
$5,859.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,358.86
|
| Rate for Payer: PACE Senior Care Partners |
$1,696.97
|
| Rate for Payer: PACE SWMI |
$1,786.29
|
| Rate for Payer: PHP Commercial |
$6,073.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,786.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,259.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,216.28
|
| Rate for Payer: Priority Health Medicare |
$1,804.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,973.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,786.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,287.73
|
| Rate for Payer: UHC Core |
$5,966.20
|
| Rate for Payer: UHC Exchange |
$1,786.29
|
| Rate for Payer: UHC Medicaid |
$1,259.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,786.29
|
| Rate for Payer: UHCCP Medicaid |
$1,259.69
|
| Rate for Payer: VA VA |
$1,786.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,358.86
|
|
|
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 |
$1,553.20 |
| Max. Negotiated Rate |
$7,929.00 |
| Rate for Payer: Aetna Commercial |
$7,488.50
|
| Rate for Payer: Aetna Medicare |
$2,290.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,753.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,753.12
|
| Rate for Payer: BCBS Complete |
$1,630.73
|
| Rate for Payer: BCBS MAPPO |
$2,202.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,242.70
|
| Rate for Payer: BCN Commercial |
$7,242.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,202.50
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Commercial |
$7,576.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,048.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,202.50
|
| Rate for Payer: Healthscope Commercial |
$7,929.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,607.50
|
| Rate for Payer: Mclaren Medicaid |
$1,553.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,312.62
|
| Rate for Payer: Meridian Medicaid |
$1,630.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,532.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,422.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: Nomi Health Commercial |
$7,224.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,607.50
|
| Rate for Payer: PACE Senior Care Partners |
$2,092.38
|
| Rate for Payer: PACE SWMI |
$2,202.50
|
| Rate for Payer: PHP Commercial |
$7,488.50
|
| Rate for Payer: PHP Medicare Advantage |
$2,202.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,553.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,664.70
|
| Rate for Payer: Priority Health Medicare |
$2,224.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,131.76
|
| Rate for Payer: Railroad Medicare Medicare |
$2,202.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,752.80
|
| Rate for Payer: UHC Core |
$7,356.35
|
| Rate for Payer: UHC Exchange |
$2,202.50
|
| Rate for Payer: UHC Medicaid |
$1,553.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,202.50
|
| Rate for Payer: UHCCP Medicaid |
$1,553.20
|
| Rate for Payer: VA VA |
$2,202.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,607.50
|
|
|
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 |
$6,131.76 |
| Max. Negotiated Rate |
$7,929.00 |
| Rate for Payer: Aetna Commercial |
$7,488.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,276.18
|
| Rate for Payer: BCN Commercial |
$7,276.18
|
| Rate for Payer: Cash Price |
$7,048.00
|
| 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: Lakeland Regional Health Systems Commercial |
$6,607.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: Nomi Health Commercial |
$7,224.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,607.50
|
| Rate for Payer: PHP Commercial |
$7,488.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,664.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,131.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,752.80
|
| Rate for Payer: UHC Core |
$7,356.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,607.50
|
|
|
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 |
$2,496.38 |
| Max. Negotiated Rate |
$12,743.86 |
| Rate for Payer: Aetna Commercial |
$12,035.87
|
| Rate for Payer: Aetna Medicare |
$3,681.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,424.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,424.95
|
| Rate for Payer: BCBS Complete |
$2,620.99
|
| Rate for Payer: BCBS MAPPO |
$3,539.96
|
| Rate for Payer: BCBS Trust/PPO |
$11,640.81
|
| Rate for Payer: BCN Commercial |
$11,640.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,539.96
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Commercial |
$12,177.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,539.96
|
| Rate for Payer: Healthscope Commercial |
$12,743.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,619.89
|
| Rate for Payer: Mclaren Medicaid |
$2,496.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,716.96
|
| Rate for Payer: Meridian Medicaid |
$2,620.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,070.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,893.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,035.87
|
| Rate for Payer: Nomi Health Commercial |
$11,611.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,619.89
|
| Rate for Payer: PACE Senior Care Partners |
$3,362.96
|
| Rate for Payer: PACE SWMI |
$3,539.96
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: PHP Medicare Advantage |
$3,539.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,496.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12,319.07
|
| Rate for Payer: Priority Health Medicare |
$3,575.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,855.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3,539.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,460.67
|
| Rate for Payer: UHC Core |
$11,823.47
|
| Rate for Payer: UHC Exchange |
$3,539.96
|
| Rate for Payer: UHC Medicaid |
$2,496.38
|
| Rate for Payer: UHC Medicare Advantage |
$3,539.96
|
| Rate for Payer: UHCCP Medicaid |
$2,496.38
|
| Rate for Payer: VA VA |
$3,539.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,619.89
|
|
|
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 |
$9,855.26 |
| Max. Negotiated Rate |
$12,743.86 |
| Rate for Payer: Aetna Commercial |
$12,035.87
|
| Rate for Payer: BCBS Trust/PPO |
$11,694.62
|
| Rate for Payer: BCN Commercial |
$11,694.62
|
| Rate for Payer: Cash Price |
$11,327.88
|
| 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: Lakeland Regional Health Systems Commercial |
$10,619.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,035.87
|
| Rate for Payer: Nomi Health Commercial |
$11,611.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,619.89
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12,319.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,855.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,460.67
|
| Rate for Payer: UHC Core |
$11,823.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,619.89
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
IP
|
$530.20
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$477.18 |
| Rate for Payer: Aetna Commercial |
$450.67
|
| Rate for Payer: BCBS Trust/PPO |
$437.89
|
| Rate for Payer: BCN Commercial |
$437.89
|
| Rate for Payer: Cash Price |
$424.16
|
| 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: Lakeland Regional Health Systems Commercial |
$397.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.67
|
| Rate for Payer: Nomi Health Commercial |
$434.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.65
|
| Rate for Payer: PHP Commercial |
$450.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$461.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$369.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.58
|
| Rate for Payer: UHC Core |
$442.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.65
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
OP
|
$530.20
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.47 |
| Max. Negotiated Rate |
$477.18 |
| Rate for Payer: Aetna Commercial |
$450.67
|
| Rate for Payer: Aetna Medicare |
$137.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.69
|
| Rate for Payer: BCBS Complete |
$98.14
|
| Rate for Payer: BCBS MAPPO |
$132.55
|
| Rate for Payer: BCBS Trust/PPO |
$435.88
|
| Rate for Payer: BCN Commercial |
$435.88
|
| Rate for Payer: BCN Medicare Advantage |
$132.55
|
| Rate for Payer: Cash Price |
$424.16
|
| Rate for Payer: Cash Price |
$424.16
|
| 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 |
$132.55
|
| Rate for Payer: Healthscope Commercial |
$477.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.65
|
| Rate for Payer: Mclaren Medicaid |
$93.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.18
|
| Rate for Payer: Meridian Medicaid |
$98.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.67
|
| Rate for Payer: Nomi Health Commercial |
$434.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.65
|
| Rate for Payer: PACE Senior Care Partners |
$125.92
|
| Rate for Payer: PACE SWMI |
$132.55
|
| Rate for Payer: PHP Commercial |
$450.67
|
| Rate for Payer: PHP Medicare Advantage |
$132.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$461.27
|
| Rate for Payer: Priority Health Medicare |
$133.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$369.02
|
| Rate for Payer: Railroad Medicare Medicare |
$132.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.58
|
| Rate for Payer: UHC Core |
$442.72
|
| Rate for Payer: UHC Exchange |
$132.55
|
| Rate for Payer: UHC Medicaid |
$93.47
|
| Rate for Payer: UHC Medicare Advantage |
$132.55
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$132.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.65
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
OP
|
$4,737.42
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$835.21 |
| Max. Negotiated Rate |
$4,263.68 |
| Rate for Payer: Aetna Commercial |
$4,026.81
|
| Rate for Payer: Aetna Medicare |
$1,231.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,480.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,480.44
|
| Rate for Payer: BCBS Complete |
$876.90
|
| Rate for Payer: BCBS MAPPO |
$1,184.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,894.63
|
| Rate for Payer: BCN Commercial |
$3,894.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,184.36
|
| Rate for Payer: Cash Price |
$3,789.94
|
| 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 |
$1,184.36
|
| Rate for Payer: Healthscope Commercial |
$4,263.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,553.07
|
| Rate for Payer: Mclaren Medicaid |
$835.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,243.57
|
| Rate for Payer: Meridian Medicaid |
$876.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,362.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,302.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,026.81
|
| Rate for Payer: Nomi Health Commercial |
$3,884.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,553.07
|
| Rate for Payer: PACE Senior Care Partners |
$1,125.14
|
| Rate for Payer: PACE SWMI |
$1,184.36
|
| Rate for Payer: PHP Commercial |
$4,026.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,184.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,121.56
|
| Rate for Payer: Priority Health Medicare |
$1,196.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,297.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1,184.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,168.93
|
| Rate for Payer: UHC Core |
$3,955.75
|
| Rate for Payer: UHC Exchange |
$1,184.36
|
| Rate for Payer: UHC Medicaid |
$835.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,184.36
|
| Rate for Payer: UHCCP Medicaid |
$835.21
|
| Rate for Payer: VA VA |
$1,184.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,553.07
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
IP
|
$4,737.42
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,297.24 |
| Max. Negotiated Rate |
$4,263.68 |
| Rate for Payer: Aetna Commercial |
$4,026.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,912.64
|
| Rate for Payer: BCN Commercial |
$3,912.64
|
| Rate for Payer: Cash Price |
$3,789.94
|
| 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: Lakeland Regional Health Systems Commercial |
$3,553.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,026.81
|
| Rate for Payer: Nomi Health Commercial |
$3,884.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,553.07
|
| Rate for Payer: PHP Commercial |
$4,026.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,121.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,297.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,168.93
|
| Rate for Payer: UHC Core |
$3,955.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,553.07
|
|
