|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
IP
|
$102.93
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.05 |
| Max. Negotiated Rate |
$102.93 |
| Rate for Payer: Aetna Commercial |
$92.64
|
| Rate for Payer: ASR ASR |
$99.84
|
| Rate for Payer: BCBS Trust/PPO |
$79.80
|
| Rate for Payer: BCN Commercial |
$79.80
|
| Rate for Payer: Cash Price |
$82.34
|
| Rate for Payer: Cofinity Commercial |
$96.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.34
|
| Rate for Payer: Healthscope Commercial |
$102.93
|
| Rate for Payer: Healthscope Whirlpool |
$99.84
|
| Rate for Payer: Mclaren Commercial |
$92.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.58
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
OP
|
$1,023.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$1,023.75 |
| Rate for Payer: Aetna Commercial |
$921.38
|
| Rate for Payer: ASR ASR |
$993.04
|
| Rate for Payer: BCBS Complete |
$409.50
|
| Rate for Payer: BCBS Trust/PPO |
$793.71
|
| Rate for Payer: BCN Commercial |
$793.71
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cofinity Commercial |
$962.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.00
|
| Rate for Payer: Healthscope Commercial |
$1,023.75
|
| Rate for Payer: Healthscope Whirlpool |
$993.04
|
| Rate for Payer: Mclaren Commercial |
$921.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$931.61
|
| Rate for Payer: Priority Health Narrow Network |
$726.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$900.90
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
IP
|
$1,023.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$716.62 |
| Max. Negotiated Rate |
$1,023.75 |
| Rate for Payer: Aetna Commercial |
$921.38
|
| Rate for Payer: ASR ASR |
$993.04
|
| Rate for Payer: BCBS Trust/PPO |
$793.71
|
| Rate for Payer: BCN Commercial |
$793.71
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cofinity Commercial |
$962.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.00
|
| Rate for Payer: Healthscope Commercial |
$1,023.75
|
| Rate for Payer: Healthscope Whirlpool |
$993.04
|
| Rate for Payer: Mclaren Commercial |
$921.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$900.90
|
|
|
HC THROMBO EMBO CATHETER LVL 13
|
Facility
|
IP
|
$1,339.02
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$937.31 |
| Max. Negotiated Rate |
$1,339.02 |
| Rate for Payer: Aetna Commercial |
$1,205.12
|
| Rate for Payer: ASR ASR |
$1,298.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,038.14
|
| Rate for Payer: BCN Commercial |
$1,038.14
|
| Rate for Payer: Cash Price |
$1,071.22
|
| Rate for Payer: Cofinity Commercial |
$1,258.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.22
|
| Rate for Payer: Healthscope Commercial |
$1,339.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,298.85
|
| Rate for Payer: Mclaren Commercial |
$1,205.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,138.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$937.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,178.34
|
|
|
HC THROMBO EMBO CATHETER LVL 13
|
Facility
|
OP
|
$1,339.02
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.61 |
| Max. Negotiated Rate |
$1,339.02 |
| Rate for Payer: Aetna Commercial |
$1,205.12
|
| Rate for Payer: ASR ASR |
$1,298.85
|
| Rate for Payer: BCBS Complete |
$535.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,038.14
|
| Rate for Payer: BCN Commercial |
$1,038.14
|
| Rate for Payer: Cash Price |
$1,071.22
|
| Rate for Payer: Cofinity Commercial |
$1,258.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.22
|
| Rate for Payer: Healthscope Commercial |
$1,339.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,298.85
|
| Rate for Payer: Mclaren Commercial |
$1,205.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,138.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$937.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,218.51
|
| Rate for Payer: Priority Health Narrow Network |
$950.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,178.34
|
|
|
HC THROMBO EMBO CATHETER LVL 14
|
Facility
|
OP
|
$1,456.71
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.68 |
| Max. Negotiated Rate |
$1,456.71 |
| Rate for Payer: Aetna Commercial |
$1,311.04
|
| Rate for Payer: ASR ASR |
$1,413.01
|
| Rate for Payer: BCBS Complete |
$582.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,129.39
|
| Rate for Payer: BCN Commercial |
$1,129.39
|
| Rate for Payer: Cash Price |
$1,165.37
|
| Rate for Payer: Cofinity Commercial |
$1,369.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,165.37
|
| Rate for Payer: Healthscope Commercial |
$1,456.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,413.01
|
| Rate for Payer: Mclaren Commercial |
$1,311.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,325.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,034.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,281.90
|
|
|
HC THROMBO EMBO CATHETER LVL 14
|
Facility
|
IP
|
$1,456.71
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,019.70 |
| Max. Negotiated Rate |
$1,456.71 |
| Rate for Payer: Aetna Commercial |
$1,311.04
|
| Rate for Payer: ASR ASR |
$1,413.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,129.39
|
| Rate for Payer: BCN Commercial |
$1,129.39
|
| Rate for Payer: Cash Price |
$1,165.37
|
| Rate for Payer: Cofinity Commercial |
$1,369.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,165.37
|
| Rate for Payer: Healthscope Commercial |
$1,456.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,413.01
|
| Rate for Payer: Mclaren Commercial |
$1,311.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,281.90
|
|
|
HC THROMBO EMBO CATHETER LVL 33
|
Facility
|
IP
|
$3,302.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,311.40 |
| Max. Negotiated Rate |
$3,302.00 |
| Rate for Payer: Aetna Commercial |
$2,971.80
|
| Rate for Payer: ASR ASR |
$3,202.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,560.04
|
| Rate for Payer: BCN Commercial |
$2,560.04
|
| Rate for Payer: Cash Price |
$2,641.60
|
| Rate for Payer: Cofinity Commercial |
$3,103.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,641.60
|
| Rate for Payer: Healthscope Commercial |
$3,302.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,202.94
|
| Rate for Payer: Mclaren Commercial |
$2,971.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,806.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,905.76
|
|
|
HC THROMBO EMBO CATHETER LVL 33
|
Facility
|
OP
|
$3,302.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,320.80 |
| Max. Negotiated Rate |
$3,302.00 |
| Rate for Payer: Aetna Commercial |
$2,971.80
|
| Rate for Payer: ASR ASR |
$3,202.94
|
| Rate for Payer: BCBS Complete |
$1,320.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,560.04
|
| Rate for Payer: BCN Commercial |
$2,560.04
|
| Rate for Payer: Cash Price |
$2,641.60
|
| Rate for Payer: Cofinity Commercial |
$3,103.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,641.60
|
| Rate for Payer: Healthscope Commercial |
$3,302.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,202.94
|
| Rate for Payer: Mclaren Commercial |
$2,971.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,806.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,004.82
|
| Rate for Payer: Priority Health Narrow Network |
$2,344.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,905.76
|
|
|
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 |
$4,610.00 |
| Rate for Payer: Aetna Commercial |
$4,149.00
|
| Rate for Payer: ASR ASR |
$4,471.70
|
| Rate for Payer: BCBS Complete |
$1,844.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,574.13
|
| Rate for Payer: BCN Commercial |
$3,574.13
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cofinity Commercial |
$4,333.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,688.00
|
| Rate for Payer: Healthscope Commercial |
$4,610.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,471.70
|
| Rate for Payer: Mclaren Commercial |
$4,149.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,918.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,227.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,195.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,273.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,056.80
|
|
|
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 |
$3,227.00 |
| Max. Negotiated Rate |
$4,610.00 |
| Rate for Payer: Aetna Commercial |
$4,149.00
|
| Rate for Payer: ASR ASR |
$4,471.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,574.13
|
| Rate for Payer: BCN Commercial |
$3,574.13
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cofinity Commercial |
$4,333.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,688.00
|
| Rate for Payer: Healthscope Commercial |
$4,610.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,471.70
|
| Rate for Payer: Mclaren Commercial |
$4,149.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,918.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,227.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,056.80
|
|
|
HC THROMBO EMBO CATHETER LVL 71
|
Facility
|
OP
|
$7,145.15
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,858.06 |
| Max. Negotiated Rate |
$7,145.15 |
| Rate for Payer: Aetna Commercial |
$6,430.64
|
| Rate for Payer: ASR ASR |
$6,930.80
|
| Rate for Payer: BCBS Complete |
$2,858.06
|
| Rate for Payer: BCBS Trust/PPO |
$5,539.63
|
| Rate for Payer: BCN Commercial |
$5,539.63
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Commercial |
$6,716.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Healthscope Commercial |
$7,145.15
|
| Rate for Payer: Healthscope Whirlpool |
$6,930.80
|
| Rate for Payer: Mclaren Commercial |
$6,430.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,073.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,001.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,502.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,073.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,287.73
|
|
|
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 |
$5,001.60 |
| Max. Negotiated Rate |
$7,145.15 |
| Rate for Payer: Aetna Commercial |
$6,430.64
|
| Rate for Payer: ASR ASR |
$6,930.80
|
| Rate for Payer: BCBS Trust/PPO |
$5,539.63
|
| Rate for Payer: BCN Commercial |
$5,539.63
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Commercial |
$6,716.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Healthscope Commercial |
$7,145.15
|
| Rate for Payer: Healthscope Whirlpool |
$6,930.80
|
| Rate for Payer: Mclaren Commercial |
$6,430.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,073.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,001.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,287.73
|
|
|
HC THROMBO EMBO LVL 141
|
Facility
|
OP
|
$14,159.85
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
27200225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,663.94 |
| Max. Negotiated Rate |
$14,159.85 |
| Rate for Payer: Aetna Commercial |
$12,743.86
|
| Rate for Payer: ASR ASR |
$13,735.05
|
| Rate for Payer: BCBS Complete |
$5,663.94
|
| Rate for Payer: BCBS Trust/PPO |
$10,978.13
|
| Rate for Payer: BCN Commercial |
$10,978.13
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Commercial |
$13,310.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Healthscope Commercial |
$14,159.85
|
| Rate for Payer: Healthscope Whirlpool |
$13,735.05
|
| Rate for Payer: Mclaren Commercial |
$12,743.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,035.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,911.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,885.46
|
| Rate for Payer: Priority Health Narrow Network |
$10,053.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,460.67
|
|
|
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 |
$9,911.90 |
| Max. Negotiated Rate |
$14,159.85 |
| Rate for Payer: Aetna Commercial |
$12,743.86
|
| Rate for Payer: ASR ASR |
$13,735.05
|
| Rate for Payer: BCBS Trust/PPO |
$10,978.13
|
| Rate for Payer: BCN Commercial |
$10,978.13
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Commercial |
$13,310.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Healthscope Commercial |
$14,159.85
|
| Rate for Payer: Healthscope Whirlpool |
$13,735.05
|
| Rate for Payer: Mclaren Commercial |
$12,743.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,035.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,911.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,460.67
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
IP
|
$509.61
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$356.73 |
| Max. Negotiated Rate |
$509.61 |
| Rate for Payer: Aetna Commercial |
$458.65
|
| Rate for Payer: ASR ASR |
$494.32
|
| Rate for Payer: BCBS Trust/PPO |
$395.10
|
| Rate for Payer: BCN Commercial |
$395.10
|
| Rate for Payer: Cash Price |
$407.69
|
| Rate for Payer: Cofinity Commercial |
$479.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.69
|
| Rate for Payer: Healthscope Commercial |
$509.61
|
| Rate for Payer: Healthscope Whirlpool |
$494.32
|
| Rate for Payer: Mclaren Commercial |
$458.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.46
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
OP
|
$509.61
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.66 |
| Max. Negotiated Rate |
$509.61 |
| Rate for Payer: Aetna Commercial |
$458.65
|
| Rate for Payer: Aetna Medicare |
$301.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.29
|
| Rate for Payer: ASR ASR |
$494.32
|
| Rate for Payer: BCBS Complete |
$172.91
|
| Rate for Payer: BCBS MAPPO |
$301.03
|
| Rate for Payer: BCBS Trust/PPO |
$395.10
|
| Rate for Payer: BCN Commercial |
$395.10
|
| Rate for Payer: BCN Medicare Advantage |
$301.03
|
| Rate for Payer: Cash Price |
$407.69
|
| Rate for Payer: Cash Price |
$407.69
|
| Rate for Payer: Cofinity Commercial |
$479.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.03
|
| Rate for Payer: Healthscope Commercial |
$509.61
|
| Rate for Payer: Healthscope Whirlpool |
$494.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$301.03
|
| Rate for Payer: Mclaren Commercial |
$458.65
|
| Rate for Payer: Mclaren Medicaid |
$164.66
|
| Rate for Payer: Mclaren Medicare |
$301.03
|
| Rate for Payer: Meridian Medicaid |
$172.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.17
|
| Rate for Payer: PACE Medicare |
$285.98
|
| Rate for Payer: PACE SWMI |
$301.03
|
| Rate for Payer: PHP Commercial |
$331.13
|
| Rate for Payer: PHP Medicaid |
$164.66
|
| Rate for Payer: PHP Medicare Advantage |
$301.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.45
|
| Rate for Payer: Priority Health Medicare |
$301.03
|
| Rate for Payer: Priority Health Narrow Network |
$265.16
|
| Rate for Payer: Railroad Medicare Medicare |
$301.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.46
|
| Rate for Payer: UHC Medicare Advantage |
$310.06
|
| Rate for Payer: VA VA |
$301.03
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
IP
|
$4,553.46
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,187.42 |
| Max. Negotiated Rate |
$4,553.46 |
| Rate for Payer: Aetna Commercial |
$4,098.11
|
| Rate for Payer: ASR ASR |
$4,416.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,530.30
|
| Rate for Payer: BCN Commercial |
$3,530.30
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cofinity Commercial |
$4,280.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,642.77
|
| Rate for Payer: Healthscope Commercial |
$4,553.46
|
| Rate for Payer: Healthscope Whirlpool |
$4,416.86
|
| Rate for Payer: Mclaren Commercial |
$4,098.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,870.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,007.04
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
OP
|
$4,553.46
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,501.51 |
| Max. Negotiated Rate |
$4,553.46 |
| Rate for Payer: Aetna Commercial |
$4,098.11
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$4,416.86
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$3,530.30
|
| Rate for Payer: BCN Commercial |
$3,530.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cofinity Commercial |
$4,280.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,642.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$4,553.46
|
| Rate for Payer: Healthscope Whirlpool |
$4,416.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$4,098.11
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,870.44
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,876.89
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,501.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,007.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC THSD7
|
Facility
|
IP
|
$372.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$261.03 |
| Max. Negotiated Rate |
$372.90 |
| Rate for Payer: Aetna Commercial |
$335.61
|
| Rate for Payer: ASR ASR |
$361.71
|
| Rate for Payer: BCBS Trust/PPO |
$289.11
|
| Rate for Payer: BCN Commercial |
$289.11
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cofinity Commercial |
$350.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.32
|
| Rate for Payer: Healthscope Commercial |
$372.90
|
| Rate for Payer: Healthscope Whirlpool |
$361.71
|
| Rate for Payer: Mclaren Commercial |
$335.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.15
|
|
|
HC THSD7
|
Facility
|
OP
|
$372.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$372.90 |
| Rate for Payer: Aetna Commercial |
$335.61
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$361.71
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$289.11
|
| Rate for Payer: BCN Commercial |
$289.11
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cofinity Commercial |
$350.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$372.90
|
| Rate for Payer: Healthscope Whirlpool |
$361.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$335.61
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.96
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.42
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$169.94
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.15
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC THYROGLOBULIN
|
Facility
|
IP
|
$56.75
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.72 |
| Max. Negotiated Rate |
$56.75 |
| Rate for Payer: Aetna Commercial |
$51.08
|
| Rate for Payer: ASR ASR |
$55.05
|
| Rate for Payer: BCBS Trust/PPO |
$44.00
|
| Rate for Payer: BCN Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$45.40
|
| Rate for Payer: Cofinity Commercial |
$53.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.40
|
| Rate for Payer: Healthscope Commercial |
$56.75
|
| Rate for Payer: Healthscope Whirlpool |
$55.05
|
| Rate for Payer: Mclaren Commercial |
$51.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.94
|
|
|
HC THYROGLOBULIN
|
Facility
|
OP
|
$56.75
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$56.75 |
| Rate for Payer: Aetna Commercial |
$51.08
|
| Rate for Payer: Aetna Medicare |
$16.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.08
|
| Rate for Payer: ASR ASR |
$55.05
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS MAPPO |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$44.00
|
| Rate for Payer: BCN Commercial |
$44.00
|
| Rate for Payer: BCN Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$45.40
|
| Rate for Payer: Cash Price |
$45.40
|
| Rate for Payer: Cofinity Commercial |
$53.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$56.75
|
| Rate for Payer: Healthscope Whirlpool |
$55.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.06
|
| Rate for Payer: Mclaren Commercial |
$51.08
|
| Rate for Payer: Mclaren Medicaid |
$8.78
|
| Rate for Payer: Mclaren Medicare |
$16.06
|
| Rate for Payer: Meridian Medicaid |
$9.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.24
|
| Rate for Payer: PACE Medicare |
$15.26
|
| Rate for Payer: PACE SWMI |
$16.06
|
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: PHP Medicaid |
$8.78
|
| Rate for Payer: PHP Medicare Advantage |
$16.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.44
|
| Rate for Payer: Priority Health Medicare |
$16.06
|
| Rate for Payer: Priority Health Narrow Network |
$45.15
|
| Rate for Payer: Railroad Medicare Medicare |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.94
|
| Rate for Payer: UHC Medicare Advantage |
$16.54
|
| Rate for Payer: VA VA |
$16.06
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
IP
|
$59.06
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$59.06 |
| Rate for Payer: Aetna Commercial |
$53.15
|
| Rate for Payer: ASR ASR |
$57.29
|
| Rate for Payer: BCBS Trust/PPO |
$45.79
|
| Rate for Payer: BCN Commercial |
$45.79
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cofinity Commercial |
$55.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.25
|
| Rate for Payer: Healthscope Commercial |
$59.06
|
| Rate for Payer: Healthscope Whirlpool |
$57.29
|
| Rate for Payer: Mclaren Commercial |
$53.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.97
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
OP
|
$59.06
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$59.06 |
| Rate for Payer: Aetna Commercial |
$53.15
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.89
|
| Rate for Payer: ASR ASR |
$57.29
|
| Rate for Payer: BCBS Complete |
$9.14
|
| Rate for Payer: BCBS MAPPO |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$45.79
|
| Rate for Payer: BCN Commercial |
$45.79
|
| Rate for Payer: BCN Medicare Advantage |
$15.91
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cofinity Commercial |
$55.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.91
|
| Rate for Payer: Healthscope Commercial |
$59.06
|
| Rate for Payer: Healthscope Whirlpool |
$57.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.91
|
| Rate for Payer: Mclaren Commercial |
$53.15
|
| Rate for Payer: Mclaren Medicaid |
$8.70
|
| Rate for Payer: Mclaren Medicare |
$15.91
|
| Rate for Payer: Meridian Medicaid |
$9.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.20
|
| Rate for Payer: PACE Medicare |
$15.11
|
| Rate for Payer: PACE SWMI |
$15.91
|
| Rate for Payer: PHP Commercial |
$17.50
|
| Rate for Payer: PHP Medicaid |
$8.70
|
| Rate for Payer: PHP Medicare Advantage |
$15.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.44
|
| Rate for Payer: Priority Health Medicare |
$15.91
|
| Rate for Payer: Priority Health Narrow Network |
$45.15
|
| Rate for Payer: Railroad Medicare Medicare |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.97
|
| Rate for Payer: UHC Medicare Advantage |
$16.39
|
| Rate for Payer: VA VA |
$15.91
|
|
