|
HC THORACIC FASCIAL PLANE BLOCK BILAT INJ
|
Facility
|
IP
|
$1,111.79
|
|
|
Service Code
|
CPT 64468
|
| Hospital Charge Code |
37000022
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$833.84 |
| Max. Negotiated Rate |
$1,111.79 |
| Rate for Payer: Aetna Commercial |
$1,000.61
|
| Rate for Payer: ASR ASR |
$1,078.44
|
| Rate for Payer: BCBS Trust/PPO |
$913.00
|
| Rate for Payer: BCN Commercial |
$913.00
|
| Rate for Payer: Cash Price |
$889.43
|
| Rate for Payer: Cofinity Commercial |
$1,045.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.43
|
| Rate for Payer: Healthscope Commercial |
$1,078.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,111.79
|
| Rate for Payer: Mclaren Commercial |
$1,000.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.02
|
| Rate for Payer: Nomi Health Commercial |
$911.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$978.38
|
|
|
HC THORACIC FASCIAL PLANE BLOCK UNILAT CONT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 64467
|
| Hospital Charge Code |
37000027
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: ASR ASR |
$727.50
|
| Rate for Payer: BCBS Trust/PPO |
$615.90
|
| Rate for Payer: BCN Commercial |
$615.90
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$705.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.00
|
| Rate for Payer: Healthscope Commercial |
$727.50
|
| Rate for Payer: Healthscope Whirlpool |
$750.00
|
| Rate for Payer: Mclaren Commercial |
$675.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$637.50
|
| Rate for Payer: Nomi Health Commercial |
$615.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$562.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.00
|
|
|
HC THORACIC FASCIAL PLANE BLOCK UNILAT CONT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 64467
|
| Hospital Charge Code |
37000027
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$277.50 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare |
$277.50
|
| Rate for Payer: ASR ASR |
$727.50
|
| Rate for Payer: BCBS Complete |
$300.00
|
| Rate for Payer: BCBS Trust/PPO |
$618.38
|
| Rate for Payer: BCN Commercial |
$618.38
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$705.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.00
|
| Rate for Payer: Healthscope Commercial |
$727.50
|
| Rate for Payer: Healthscope Whirlpool |
$750.00
|
| Rate for Payer: Mclaren Commercial |
$675.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$600.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$637.50
|
| Rate for Payer: Nomi Health Commercial |
$615.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$562.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$530.66
|
| Rate for Payer: Priority Health Narrow Network |
$424.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.00
|
|
|
HC THORACIC FASCIAL PLANE BLOCK UNILAT INJ
|
Facility
|
IP
|
$741.19
|
|
|
Service Code
|
CPT 64466
|
| Hospital Charge Code |
37000021
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$555.89 |
| Max. Negotiated Rate |
$741.19 |
| Rate for Payer: Aetna Commercial |
$667.07
|
| Rate for Payer: ASR ASR |
$718.95
|
| Rate for Payer: BCBS Trust/PPO |
$608.67
|
| Rate for Payer: BCN Commercial |
$608.67
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cofinity Commercial |
$696.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.95
|
| Rate for Payer: Healthscope Commercial |
$718.95
|
| Rate for Payer: Healthscope Whirlpool |
$741.19
|
| Rate for Payer: Mclaren Commercial |
$667.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.01
|
| Rate for Payer: Nomi Health Commercial |
$607.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$652.25
|
|
|
HC THORACIC FASCIAL PLANE BLOCK UNILAT INJ
|
Facility
|
OP
|
$741.19
|
|
|
Service Code
|
CPT 64466
|
| Hospital Charge Code |
37000021
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$176.30 |
| Max. Negotiated Rate |
$741.19 |
| Rate for Payer: Aetna Commercial |
$667.07
|
| Rate for Payer: Aetna Medicare |
$274.24
|
| Rate for Payer: ASR ASR |
$718.95
|
| Rate for Payer: BCBS Complete |
$296.48
|
| Rate for Payer: BCBS Trust/PPO |
$611.11
|
| Rate for Payer: BCN Commercial |
$611.11
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cofinity Commercial |
$696.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.95
|
| Rate for Payer: Healthscope Commercial |
$718.95
|
| Rate for Payer: Healthscope Whirlpool |
$741.19
|
| Rate for Payer: Mclaren Commercial |
$667.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$592.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.01
|
| Rate for Payer: Nomi Health Commercial |
$607.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$220.37
|
| Rate for Payer: Priority Health Narrow Network |
$176.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$652.25
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$539.25 |
| Max. Negotiated Rate |
$719.00 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: ASR ASR |
$697.43
|
| Rate for Payer: BCBS Trust/PPO |
$590.44
|
| Rate for Payer: BCN Commercial |
$590.44
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$675.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Healthscope Commercial |
$697.43
|
| Rate for Payer: Healthscope Whirlpool |
$719.00
|
| Rate for Payer: Mclaren Commercial |
$647.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: Nomi Health Commercial |
$589.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$632.72
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$100.72 |
| Max. Negotiated Rate |
$719.00 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$697.43
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$592.82
|
| Rate for Payer: BCN Commercial |
$592.82
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$675.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$697.43
|
| Rate for Payer: Healthscope Whirlpool |
$719.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$647.10
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$204.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: Nomi Health Commercial |
$589.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.25
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$125.89
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$100.72
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$632.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC THORACOTOMY
|
Facility
|
OP
|
$2,133.72
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$789.48 |
| Max. Negotiated Rate |
$2,133.72 |
| Rate for Payer: Aetna Commercial |
$1,920.35
|
| Rate for Payer: Aetna Medicare |
$789.48
|
| Rate for Payer: ASR ASR |
$2,069.71
|
| Rate for Payer: BCBS Complete |
$853.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,759.25
|
| Rate for Payer: BCN Commercial |
$1,759.25
|
| Rate for Payer: Cash Price |
$1,706.98
|
| Rate for Payer: Cofinity Commercial |
$2,005.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.98
|
| Rate for Payer: Healthscope Commercial |
$2,069.71
|
| Rate for Payer: Healthscope Whirlpool |
$2,133.72
|
| Rate for Payer: Mclaren Commercial |
$1,920.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,706.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,813.66
|
| Rate for Payer: Nomi Health Commercial |
$1,749.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,600.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,869.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,495.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,877.67
|
|
|
HC THORACOTOMY
|
Facility
|
IP
|
$2,133.72
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,600.29 |
| Max. Negotiated Rate |
$2,133.72 |
| Rate for Payer: Aetna Commercial |
$1,920.35
|
| Rate for Payer: ASR ASR |
$2,069.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,752.21
|
| Rate for Payer: BCN Commercial |
$1,752.21
|
| Rate for Payer: Cash Price |
$1,706.98
|
| Rate for Payer: Cofinity Commercial |
$2,005.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.98
|
| Rate for Payer: Healthscope Commercial |
$2,069.71
|
| Rate for Payer: Healthscope Whirlpool |
$2,133.72
|
| Rate for Payer: Mclaren Commercial |
$1,920.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,813.66
|
| Rate for Payer: Nomi Health Commercial |
$1,749.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,600.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,877.67
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
IP
|
$5,067.48
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,800.61 |
| Max. Negotiated Rate |
$5,067.48 |
| Rate for Payer: Aetna Commercial |
$4,560.73
|
| Rate for Payer: ASR ASR |
$4,915.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,161.41
|
| Rate for Payer: BCN Commercial |
$4,161.41
|
| Rate for Payer: Cash Price |
$4,053.98
|
| Rate for Payer: Cofinity Commercial |
$4,763.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,053.98
|
| Rate for Payer: Healthscope Commercial |
$4,915.46
|
| Rate for Payer: Healthscope Whirlpool |
$5,067.48
|
| Rate for Payer: Mclaren Commercial |
$4,560.73
|
| 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: UHC All Payor (Choice/PPO) + Core |
$4,459.38
|
|
|
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 |
$1,874.97 |
| Max. Negotiated Rate |
$5,067.48 |
| Rate for Payer: Aetna Commercial |
$4,560.73
|
| Rate for Payer: Aetna Medicare |
$1,874.97
|
| Rate for Payer: ASR ASR |
$4,915.46
|
| Rate for Payer: BCBS Complete |
$2,026.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,178.14
|
| Rate for Payer: BCN Commercial |
$4,178.14
|
| Rate for Payer: Cash Price |
$4,053.98
|
| Rate for Payer: Cofinity Commercial |
$4,763.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,053.98
|
| Rate for Payer: Healthscope Commercial |
$4,915.46
|
| Rate for Payer: Healthscope Whirlpool |
$5,067.48
|
| Rate for Payer: Mclaren Commercial |
$4,560.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,053.98
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,440.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,552.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,459.38
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$77.47 |
| Rate for Payer: Aetna Commercial |
$69.72
|
| Rate for Payer: ASR ASR |
$75.15
|
| Rate for Payer: BCBS Trust/PPO |
$63.62
|
| Rate for Payer: BCN Commercial |
$63.62
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$72.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$75.15
|
| Rate for Payer: Healthscope Whirlpool |
$77.47
|
| Rate for Payer: Mclaren Commercial |
$69.72
|
| 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: UHC All Payor (Choice/PPO) + Core |
$68.17
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$77.47
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$77.47 |
| Rate for Payer: Aetna Commercial |
$69.72
|
| Rate for Payer: Aetna Medicare |
$5.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.21
|
| Rate for Payer: ASR ASR |
$75.15
|
| Rate for Payer: BCBS Complete |
$3.17
|
| Rate for Payer: BCBS MAPPO |
$5.77
|
| Rate for Payer: BCBS Trust/PPO |
$63.87
|
| Rate for Payer: BCN Commercial |
$63.87
|
| Rate for Payer: BCN Medicare Advantage |
$5.77
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$72.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.77
|
| Rate for Payer: Healthscope Commercial |
$75.15
|
| Rate for Payer: Healthscope Whirlpool |
$77.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.77
|
| Rate for Payer: Mclaren Commercial |
$69.72
|
| Rate for Payer: Mclaren Medicaid |
$5.77
|
| Rate for Payer: Mclaren Medicare |
$5.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.06
|
| Rate for Payer: Meridian Medicaid |
$3.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PACE Medicare |
$5.48
|
| Rate for Payer: PACE SWMI |
$5.77
|
| Rate for Payer: PHP Commercial |
$6.35
|
| Rate for Payer: PHP Medicaid |
$3.09
|
| Rate for Payer: PHP Medicare Advantage |
$5.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.88
|
| Rate for Payer: Priority Health Medicare |
$5.77
|
| Rate for Payer: Priority Health Narrow Network |
$54.31
|
| Rate for Payer: Railroad Medicare Medicare |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.77
|
| Rate for Payer: UHC Exchange |
$8.94
|
| Rate for Payer: UHC Medicaid |
$3.02
|
| Rate for Payer: UHCCP DNSP |
$5.77
|
| Rate for Payer: UHCCP Medicaid |
$3.02
|
| Rate for Payer: VA VA |
$5.77
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
OP
|
$104.99
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$104.99 |
| Rate for Payer: Aetna Commercial |
$94.49
|
| Rate for Payer: Aetna Medicare |
$38.85
|
| Rate for Payer: ASR ASR |
$101.84
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS Trust/PPO |
$86.56
|
| Rate for Payer: BCN Commercial |
$86.56
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Cofinity Commercial |
$98.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$101.84
|
| Rate for Payer: Healthscope Whirlpool |
$104.99
|
| Rate for Payer: Mclaren Commercial |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.24
|
| Rate for Payer: Nomi Health Commercial |
$86.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91.99
|
| Rate for Payer: Priority Health Narrow Network |
$73.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.39
|
|
|
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 |
$78.74 |
| Max. Negotiated Rate |
$104.99 |
| Rate for Payer: Aetna Commercial |
$94.49
|
| Rate for Payer: ASR ASR |
$101.84
|
| Rate for Payer: BCBS Trust/PPO |
$86.22
|
| Rate for Payer: BCN Commercial |
$86.22
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Cofinity Commercial |
$98.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$101.84
|
| Rate for Payer: Healthscope Whirlpool |
$104.99
|
| Rate for Payer: Mclaren Commercial |
$94.49
|
| 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: UHC All Payor (Choice/PPO) + Core |
$92.39
|
|
|
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 |
$386.37 |
| Max. Negotiated Rate |
$1,044.23 |
| Rate for Payer: Aetna Commercial |
$939.81
|
| Rate for Payer: Aetna Medicare |
$386.37
|
| Rate for Payer: ASR ASR |
$1,012.90
|
| Rate for Payer: BCBS Complete |
$417.69
|
| Rate for Payer: BCBS Trust/PPO |
$860.97
|
| Rate for Payer: BCN Commercial |
$860.97
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Commercial |
$981.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$1,012.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,044.23
|
| Rate for Payer: Mclaren Commercial |
$939.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$835.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Nomi Health Commercial |
$856.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$914.95
|
| Rate for Payer: Priority Health Narrow Network |
$732.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$918.92
|
|
|
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 |
$783.17 |
| Max. Negotiated Rate |
$1,044.23 |
| Rate for Payer: Aetna Commercial |
$939.81
|
| Rate for Payer: ASR ASR |
$1,012.90
|
| Rate for Payer: BCBS Trust/PPO |
$857.52
|
| Rate for Payer: BCN Commercial |
$857.52
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Commercial |
$981.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$1,012.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,044.23
|
| Rate for Payer: Mclaren Commercial |
$939.81
|
| 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: UHC All Payor (Choice/PPO) + Core |
$918.92
|
|
|
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 |
$1,024.35 |
| Max. Negotiated Rate |
$1,365.80 |
| Rate for Payer: Aetna Commercial |
$1,229.22
|
| Rate for Payer: ASR ASR |
$1,324.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,121.59
|
| Rate for Payer: BCN Commercial |
$1,121.59
|
| Rate for Payer: Cash Price |
$1,092.64
|
| Rate for Payer: Cofinity Commercial |
$1,283.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,092.64
|
| Rate for Payer: Healthscope Commercial |
$1,324.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,365.80
|
| Rate for Payer: Mclaren Commercial |
$1,229.22
|
| 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: UHC All Payor (Choice/PPO) + Core |
$1,201.90
|
|
|
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 |
$505.35 |
| Max. Negotiated Rate |
$1,365.80 |
| Rate for Payer: Aetna Commercial |
$1,229.22
|
| Rate for Payer: Aetna Medicare |
$505.35
|
| Rate for Payer: ASR ASR |
$1,324.83
|
| Rate for Payer: BCBS Complete |
$546.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.10
|
| Rate for Payer: BCN Commercial |
$1,126.10
|
| Rate for Payer: Cash Price |
$1,092.64
|
| Rate for Payer: Cofinity Commercial |
$1,283.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,092.64
|
| Rate for Payer: Healthscope Commercial |
$1,324.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,365.80
|
| Rate for Payer: Mclaren Commercial |
$1,229.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,092.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,160.93
|
| Rate for Payer: Nomi Health Commercial |
$1,119.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,024.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,196.71
|
| Rate for Payer: Priority Health Narrow Network |
$957.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,201.90
|
|
|
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 |
$549.76 |
| Max. Negotiated Rate |
$1,485.84 |
| Rate for Payer: Aetna Commercial |
$1,337.26
|
| Rate for Payer: Aetna Medicare |
$549.76
|
| Rate for Payer: ASR ASR |
$1,441.26
|
| Rate for Payer: BCBS Complete |
$594.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,225.08
|
| Rate for Payer: BCN Commercial |
$1,225.08
|
| Rate for Payer: Cash Price |
$1,188.67
|
| Rate for Payer: Cofinity Commercial |
$1,396.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,188.67
|
| Rate for Payer: Healthscope Commercial |
$1,441.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,485.84
|
| Rate for Payer: Mclaren Commercial |
$1,337.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,188.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.96
|
| Rate for Payer: Nomi Health Commercial |
$1,218.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,114.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,301.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,041.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,307.54
|
|
|
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 |
$1,114.38 |
| Max. Negotiated Rate |
$1,485.84 |
| Rate for Payer: Aetna Commercial |
$1,337.26
|
| Rate for Payer: ASR ASR |
$1,441.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.17
|
| Rate for Payer: BCN Commercial |
$1,220.17
|
| Rate for Payer: Cash Price |
$1,188.67
|
| Rate for Payer: Cofinity Commercial |
$1,396.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,188.67
|
| Rate for Payer: Healthscope Commercial |
$1,441.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,485.84
|
| Rate for Payer: Mclaren Commercial |
$1,337.26
|
| 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: UHC All Payor (Choice/PPO) + Core |
$1,307.54
|
|
|
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 |
$2,526.03 |
| Max. Negotiated Rate |
$3,368.04 |
| Rate for Payer: Aetna Commercial |
$3,031.24
|
| Rate for Payer: ASR ASR |
$3,267.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,765.83
|
| Rate for Payer: BCN Commercial |
$2,765.83
|
| Rate for Payer: Cash Price |
$2,694.43
|
| Rate for Payer: Cofinity Commercial |
$3,165.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,694.43
|
| Rate for Payer: Healthscope Commercial |
$3,267.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,368.04
|
| Rate for Payer: Mclaren Commercial |
$3,031.24
|
| 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: UHC All Payor (Choice/PPO) + Core |
$2,963.88
|
|
|
HC THROMBO EMBO CATHETER LVL 33
|
Facility
|
OP
|
$3,368.04
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,246.17 |
| Max. Negotiated Rate |
$3,368.04 |
| Rate for Payer: Aetna Commercial |
$3,031.24
|
| Rate for Payer: Aetna Medicare |
$1,246.17
|
| Rate for Payer: ASR ASR |
$3,267.00
|
| Rate for Payer: BCBS Complete |
$1,347.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,776.95
|
| Rate for Payer: BCN Commercial |
$2,776.95
|
| Rate for Payer: Cash Price |
$2,694.43
|
| Rate for Payer: Cofinity Commercial |
$3,165.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,694.43
|
| Rate for Payer: Healthscope Commercial |
$3,267.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,368.04
|
| Rate for Payer: Mclaren Commercial |
$3,031.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,694.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,862.83
|
| Rate for Payer: Nomi Health Commercial |
$2,761.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,526.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,951.08
|
| Rate for Payer: Priority Health Narrow Network |
$2,361.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,963.88
|
|
|
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 |
$1,705.70 |
| Max. Negotiated Rate |
$4,610.00 |
| Rate for Payer: Aetna Commercial |
$4,149.00
|
| Rate for Payer: Aetna Medicare |
$1,705.70
|
| Rate for Payer: ASR ASR |
$4,471.70
|
| Rate for Payer: BCBS Complete |
$1,844.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,800.95
|
| Rate for Payer: BCN Commercial |
$3,800.95
|
| 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 |
$4,471.70
|
| Rate for Payer: Healthscope Whirlpool |
$4,610.00
|
| Rate for Payer: Mclaren Commercial |
$4,149.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,688.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,918.50
|
| Rate for Payer: Nomi Health Commercial |
$3,780.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,457.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,039.28
|
| Rate for Payer: Priority Health Narrow Network |
$3,231.61
|
| 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 |
$3,457.50 |
| 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 |
$3,785.73
|
| Rate for Payer: BCN Commercial |
$3,785.73
|
| 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 |
$4,471.70
|
| Rate for Payer: Healthscope Whirlpool |
$4,610.00
|
| Rate for Payer: Mclaren Commercial |
$4,149.00
|
| 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: UHC All Payor (Choice/PPO) + Core |
$4,056.80
|
|
