|
HC THORACOTOMY
|
Facility
|
IP
|
$2,091.88
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,359.72 |
| Max. Negotiated Rate |
$1,882.69 |
| Rate for Payer: Aetna Commercial |
$1,778.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,707.60
|
| Rate for Payer: BCN Commercial |
$1,616.60
|
| Rate for Payer: Cash Price |
$1,673.50
|
| Rate for Payer: Cofinity Commercial |
$1,799.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,673.50
|
| Rate for Payer: Healthscope Commercial |
$1,882.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,568.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,778.10
|
| Rate for Payer: Nomi Health Commercial |
$1,715.34
|
| Rate for Payer: PHP Commercial |
$1,778.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,819.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,401.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,840.85
|
| Rate for Payer: UHC Core |
$1,746.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,568.91
|
|
|
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 |
$1,179.93 |
| Max. Negotiated Rate |
$4,471.31 |
| Rate for Payer: Aetna Commercial |
$4,222.90
|
| Rate for Payer: Aetna Medicare |
$1,291.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,552.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,552.54
|
| Rate for Payer: BCBS Complete |
$1,987.25
|
| Rate for Payer: BCBS MAPPO |
$1,242.03
|
| Rate for Payer: BCBS Trust/PPO |
$4,084.29
|
| Rate for Payer: BCN Commercial |
$3,862.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,242.03
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cofinity Commercial |
$4,272.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,974.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,242.03
|
| Rate for Payer: Healthscope Commercial |
$4,471.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,726.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,304.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,428.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,222.90
|
| Rate for Payer: Nomi Health Commercial |
$4,073.86
|
| Rate for Payer: PACE Senior Care Partners |
$1,179.93
|
| Rate for Payer: PACE SWMI |
$1,242.03
|
| Rate for Payer: PHP Commercial |
$4,222.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,242.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.28
|
| Rate for Payer: Priority Health HMO/PPO |
$4,322.26
|
| Rate for Payer: Priority Health Medicare |
$1,254.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,328.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,242.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,371.95
|
| Rate for Payer: UHC Core |
$4,148.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,242.03
|
| Rate for Payer: UHC Exchange |
$1,242.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,242.03
|
| Rate for Payer: VA VA |
$1,242.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,726.09
|
|
|
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 |
$3,229.28 |
| Max. Negotiated Rate |
$4,471.31 |
| Rate for Payer: Aetna Commercial |
$4,222.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,055.48
|
| Rate for Payer: BCN Commercial |
$3,839.36
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cofinity Commercial |
$4,272.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,974.50
|
| Rate for Payer: Healthscope Commercial |
$4,471.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,726.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,222.90
|
| Rate for Payer: Nomi Health Commercial |
$4,073.86
|
| Rate for Payer: PHP Commercial |
$4,222.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.28
|
| Rate for Payer: Priority Health HMO/PPO |
$4,322.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,328.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,371.95
|
| Rate for Payer: UHC Core |
$4,148.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,726.09
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna Medicare |
$19.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.73
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: BCBS MAPPO |
$18.99
|
| Rate for Payer: BCBS Trust/PPO |
$62.44
|
| Rate for Payer: BCN Commercial |
$59.05
|
| Rate for Payer: BCN Medicare Advantage |
$18.99
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.99
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Mclaren Medicaid |
$4.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.94
|
| Rate for Payer: Meridian Medicaid |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: PACE Senior Care Partners |
$18.04
|
| Rate for Payer: PACE SWMI |
$18.99
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: PHP Medicare Advantage |
$18.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO |
$66.08
|
| Rate for Payer: Priority Health Medicare |
$19.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.89
|
| Rate for Payer: Railroad Medicare Medicare |
$18.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.84
|
| Rate for Payer: UHC Core |
$63.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.99
|
| Rate for Payer: UHC Exchange |
$18.99
|
| Rate for Payer: UHC Medicare Advantage |
$18.99
|
| Rate for Payer: UHCCP Medicaid |
$4.17
|
| Rate for Payer: VA VA |
$18.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: BCBS Trust/PPO |
$62.00
|
| Rate for Payer: BCN Commercial |
$58.69
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO |
$66.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.84
|
| Rate for Payer: UHC Core |
$63.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
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 |
$24.94 |
| 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 |
$42.00
|
| Rate for Payer: BCBS MAPPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$86.31
|
| Rate for Payer: BCN Commercial |
$81.63
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.24
|
| Rate for Payer: Nomi Health Commercial |
$86.09
|
| 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 Cigna Priority Health |
$68.24
|
| Rate for Payer: Priority Health HMO/PPO |
$91.34
|
| Rate for Payer: Priority Health Medicare |
$26.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.34
|
| 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 Dual Complete DSNP |
$26.25
|
| Rate for Payer: UHC Exchange |
$26.25
|
| Rate for Payer: UHC Medicare Advantage |
$26.25
|
| 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 |
$68.24 |
| Max. Negotiated Rate |
$94.49 |
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: BCBS Trust/PPO |
$85.70
|
| Rate for Payer: BCN Commercial |
$81.14
|
| 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: PHP Commercial |
$89.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.24
|
| Rate for Payer: Priority Health HMO/PPO |
$91.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.34
|
| 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 |
$248.00 |
| 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 |
$417.69
|
| Rate for Payer: BCBS MAPPO |
$261.06
|
| Rate for Payer: BCBS Trust/PPO |
$858.46
|
| Rate for Payer: BCN Commercial |
$811.89
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$274.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Nomi Health Commercial |
$856.27
|
| 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 Cigna Priority Health |
$678.75
|
| Rate for Payer: Priority Health HMO/PPO |
$908.48
|
| Rate for Payer: Priority Health Medicare |
$263.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$699.63
|
| 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 Dual Complete DSNP |
$261.06
|
| Rate for Payer: UHC Exchange |
$261.06
|
| Rate for Payer: UHC Medicare Advantage |
$261.06
|
| 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 |
$678.75 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: BCBS Trust/PPO |
$852.40
|
| Rate for Payer: BCN Commercial |
$806.98
|
| 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: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.75
|
| Rate for Payer: Priority Health HMO/PPO |
$908.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$699.63
|
| 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 |
$324.38 |
| 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 |
$546.32
|
| Rate for Payer: BCBS MAPPO |
$341.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.82
|
| Rate for Payer: BCN Commercial |
$1,061.91
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$358.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$392.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,160.93
|
| Rate for Payer: Nomi Health Commercial |
$1,119.96
|
| 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 Cigna Priority Health |
$887.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,188.25
|
| Rate for Payer: Priority Health Medicare |
$344.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$915.09
|
| 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 Dual Complete DSNP |
$341.45
|
| Rate for Payer: UHC Exchange |
$341.45
|
| Rate for Payer: UHC Medicare Advantage |
$341.45
|
| 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 |
$887.77 |
| Max. Negotiated Rate |
$1,229.22 |
| Rate for Payer: Aetna Commercial |
$1,160.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.90
|
| Rate for Payer: BCN Commercial |
$1,055.49
|
| 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: PHP Commercial |
$1,160.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$887.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,188.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$915.09
|
| 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 |
$965.80 |
| Max. Negotiated Rate |
$1,337.26 |
| Rate for Payer: Aetna Commercial |
$1,262.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,212.89
|
| Rate for Payer: BCN Commercial |
$1,148.26
|
| 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: PHP Commercial |
$1,262.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$965.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,292.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$995.51
|
| 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 |
$352.89 |
| 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 |
$594.34
|
| Rate for Payer: BCBS MAPPO |
$371.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.51
|
| Rate for Payer: BCN Commercial |
$1,155.24
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.96
|
| Rate for Payer: Nomi Health Commercial |
$1,218.39
|
| 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 Cigna Priority Health |
$965.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,292.68
|
| Rate for Payer: Priority Health Medicare |
$375.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$995.51
|
| 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 Dual Complete DSNP |
$371.46
|
| Rate for Payer: UHC Exchange |
$371.46
|
| Rate for Payer: UHC Medicare Advantage |
$371.46
|
| 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 |
$2,189.23 |
| Max. Negotiated Rate |
$3,031.24 |
| Rate for Payer: Aetna Commercial |
$2,862.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,749.33
|
| Rate for Payer: BCN Commercial |
$2,602.82
|
| 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: PHP Commercial |
$2,862.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.23
|
| Rate for Payer: Priority Health HMO/PPO |
$2,930.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,256.59
|
| 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 |
$799.91 |
| 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 |
$1,347.22
|
| Rate for Payer: BCBS MAPPO |
$842.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,768.87
|
| Rate for Payer: BCN Commercial |
$2,618.65
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$884.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$968.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,862.83
|
| Rate for Payer: Nomi Health Commercial |
$2,761.79
|
| 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 Cigna Priority Health |
$2,189.23
|
| Rate for Payer: Priority Health HMO/PPO |
$2,930.19
|
| Rate for Payer: Priority Health Medicare |
$850.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,256.59
|
| 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 Dual Complete DSNP |
$842.01
|
| Rate for Payer: UHC Exchange |
$842.01
|
| Rate for Payer: UHC Medicare Advantage |
$842.01
|
| 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
|
IP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$4,149.00 |
| Rate for Payer: Aetna Commercial |
$3,918.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,763.14
|
| Rate for Payer: BCN Commercial |
$3,562.61
|
| 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: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,996.50
|
| Rate for Payer: Priority Health HMO/PPO |
$4,010.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,088.70
|
| 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 46
|
Facility
|
OP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,094.88 |
| 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 |
$1,844.00
|
| Rate for Payer: BCBS MAPPO |
$1,152.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,789.88
|
| Rate for Payer: BCN Commercial |
$3,584.28
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,210.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,325.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,918.50
|
| Rate for Payer: Nomi Health Commercial |
$3,780.20
|
| 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 Cigna Priority Health |
$2,996.50
|
| Rate for Payer: Priority Health HMO/PPO |
$4,010.70
|
| Rate for Payer: Priority Health Medicare |
$1,164.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,088.70
|
| 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 Dual Complete DSNP |
$1,152.50
|
| Rate for Payer: UHC Exchange |
$1,152.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,152.50
|
| 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 71
|
Facility
|
IP
|
$7,145.15
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,644.35 |
| Max. Negotiated Rate |
$6,430.64 |
| Rate for Payer: Aetna Commercial |
$6,073.38
|
| Rate for Payer: BCBS Trust/PPO |
$5,832.59
|
| Rate for Payer: BCN Commercial |
$5,521.77
|
| 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: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,644.35
|
| Rate for Payer: Priority Health HMO/PPO |
$6,216.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,787.25
|
| 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 |
$1,696.97 |
| 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 |
$2,858.06
|
| Rate for Payer: BCBS MAPPO |
$1,786.29
|
| Rate for Payer: BCBS Trust/PPO |
$5,874.03
|
| Rate for Payer: BCN Commercial |
$5,555.35
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,875.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,054.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,073.38
|
| Rate for Payer: Nomi Health Commercial |
$5,859.02
|
| 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 Cigna Priority Health |
$4,644.35
|
| Rate for Payer: Priority Health HMO/PPO |
$6,216.28
|
| Rate for Payer: Priority Health Medicare |
$1,804.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,787.25
|
| 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 Dual Complete DSNP |
$1,786.29
|
| Rate for Payer: UHC Exchange |
$1,786.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,786.29
|
| 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
|
IP
|
$8,810.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,726.50 |
| Max. Negotiated Rate |
$7,929.00 |
| Rate for Payer: Aetna Commercial |
$7,488.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,191.60
|
| Rate for Payer: BCN Commercial |
$6,808.37
|
| 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: PHP Commercial |
$7,488.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,726.50
|
| Rate for Payer: Priority Health HMO/PPO |
$7,664.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,902.70
|
| 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 CATHETER LVL 88
|
Facility
|
OP
|
$8,810.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,092.38 |
| 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 |
$3,524.00
|
| Rate for Payer: BCBS MAPPO |
$2,202.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,242.70
|
| Rate for Payer: BCN Commercial |
$6,849.78
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,312.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,532.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: Nomi Health Commercial |
$7,224.20
|
| 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 Cigna Priority Health |
$5,726.50
|
| Rate for Payer: Priority Health HMO/PPO |
$7,664.70
|
| Rate for Payer: Priority Health Medicare |
$2,224.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,902.70
|
| 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 Dual Complete DSNP |
$2,202.50
|
| Rate for Payer: UHC Exchange |
$2,202.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,202.50
|
| Rate for Payer: VA VA |
$2,202.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,607.50
|
|
|
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 |
$9,203.90 |
| Max. Negotiated Rate |
$12,743.86 |
| Rate for Payer: Aetna Commercial |
$12,035.87
|
| Rate for Payer: BCBS Trust/PPO |
$11,558.69
|
| Rate for Payer: BCN Commercial |
$10,942.73
|
| 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: PHP Commercial |
$12,035.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,203.90
|
| Rate for Payer: Priority Health HMO/PPO |
$12,319.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,487.10
|
| 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 THROMBO EMBO LVL 141
|
Facility
|
OP
|
$14,159.85
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
27200225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,362.96 |
| 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 |
$5,663.94
|
| Rate for Payer: BCBS MAPPO |
$3,539.96
|
| Rate for Payer: BCBS Trust/PPO |
$11,640.81
|
| Rate for Payer: BCN Commercial |
$11,009.28
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,716.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,070.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,035.87
|
| Rate for Payer: Nomi Health Commercial |
$11,611.08
|
| 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 Cigna Priority Health |
$9,203.90
|
| Rate for Payer: Priority Health HMO/PPO |
$12,319.07
|
| Rate for Payer: Priority Health Medicare |
$3,575.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,487.10
|
| 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 Dual Complete DSNP |
$3,539.96
|
| Rate for Payer: UHC Exchange |
$3,539.96
|
| Rate for Payer: UHC Medicare Advantage |
$3,539.96
|
| Rate for Payer: VA VA |
$3,539.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,619.89
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
OP
|
$519.80
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$467.82 |
| Rate for Payer: Aetna Commercial |
$441.83
|
| Rate for Payer: Aetna Medicare |
$135.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.44
|
| Rate for Payer: BCBS Complete |
$246.72
|
| Rate for Payer: BCBS MAPPO |
$129.95
|
| Rate for Payer: BCBS Trust/PPO |
$427.33
|
| Rate for Payer: BCN Commercial |
$404.14
|
| Rate for Payer: BCN Medicare Advantage |
$129.95
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cofinity Commercial |
$447.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.95
|
| Rate for Payer: Healthscope Commercial |
$467.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.85
|
| Rate for Payer: Mclaren Medicaid |
$234.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.45
|
| Rate for Payer: Meridian Medicaid |
$246.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.83
|
| Rate for Payer: Nomi Health Commercial |
$426.24
|
| Rate for Payer: PACE Senior Care Partners |
$123.45
|
| Rate for Payer: PACE SWMI |
$129.95
|
| Rate for Payer: PHP Commercial |
$441.83
|
| Rate for Payer: PHP Medicare Advantage |
$129.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.87
|
| Rate for Payer: Priority Health HMO/PPO |
$452.23
|
| Rate for Payer: Priority Health Medicare |
$131.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.27
|
| Rate for Payer: Railroad Medicare Medicare |
$129.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.42
|
| Rate for Payer: UHC Core |
$434.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.95
|
| Rate for Payer: UHC Exchange |
$129.95
|
| Rate for Payer: UHC Medicare Advantage |
$129.95
|
| Rate for Payer: UHCCP Medicaid |
$234.96
|
| Rate for Payer: VA VA |
$129.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.85
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
IP
|
$519.80
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.87 |
| Max. Negotiated Rate |
$467.82 |
| Rate for Payer: Aetna Commercial |
$441.83
|
| Rate for Payer: BCBS Trust/PPO |
$424.31
|
| Rate for Payer: BCN Commercial |
$401.70
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cofinity Commercial |
$447.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.84
|
| Rate for Payer: Healthscope Commercial |
$467.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.83
|
| Rate for Payer: Nomi Health Commercial |
$426.24
|
| Rate for Payer: PHP Commercial |
$441.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.87
|
| Rate for Payer: Priority Health HMO/PPO |
$452.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.42
|
| Rate for Payer: UHC Core |
$434.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.85
|
|
