|
HC THORACENT WO TUBE
|
Facility
|
OP
|
$1,305.83
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
36100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.69 |
| Max. Negotiated Rate |
$1,305.83 |
| Rate for Payer: Aetna Commercial |
$1,175.25
|
| Rate for Payer: Aetna Medicare |
$605.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.20
|
| Rate for Payer: ASR ASR |
$1,266.66
|
| Rate for Payer: ASR Commercial |
$1,266.66
|
| Rate for Payer: BCBS Complete |
$340.92
|
| Rate for Payer: BCBS MAPPO |
$605.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,069.34
|
| Rate for Payer: BCN Commercial |
$1,012.41
|
| Rate for Payer: BCN Medicare Advantage |
$605.76
|
| Rate for Payer: Cash Price |
$1,044.66
|
| Rate for Payer: Cash Price |
$1,044.66
|
| Rate for Payer: Cofinity Commercial |
$1,227.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.76
|
| Rate for Payer: Healthscope Commercial |
$1,305.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,266.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$605.76
|
| Rate for Payer: Mclaren Commercial |
$1,175.25
|
| Rate for Payer: Mclaren Medicaid |
$324.69
|
| Rate for Payer: Mclaren Medicare |
$605.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.05
|
| Rate for Payer: Meridian Medicaid |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.96
|
| Rate for Payer: Nomi Health Commercial |
$1,070.78
|
| Rate for Payer: PACE Medicare |
$575.47
|
| Rate for Payer: PACE SWMI |
$605.76
|
| Rate for Payer: PHP Commercial |
$666.34
|
| Rate for Payer: PHP Medicaid |
$324.69
|
| Rate for Payer: PHP Medicare Advantage |
$605.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.15
|
| Rate for Payer: Priority Health Medicare |
$605.76
|
| Rate for Payer: Priority Health Narrow Network |
$377.72
|
| Rate for Payer: Railroad Medicare Medicare |
$605.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,149.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.76
|
| Rate for Payer: UHC Exchange |
$938.93
|
| Rate for Payer: UHC Medicare Advantage |
$605.76
|
| Rate for Payer: UHCCP DNSP |
$605.76
|
| Rate for Payer: UHCCP Medicaid |
$324.69
|
| Rate for Payer: VA VA |
$605.76
|
|
|
HC THORACENT W TUBE
|
Facility
|
OP
|
$1,414.47
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$377.72 |
| Max. Negotiated Rate |
$2,359.15 |
| Rate for Payer: Aetna Commercial |
$1,273.02
|
| Rate for Payer: Aetna Medicare |
$1,522.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,902.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,902.54
|
| Rate for Payer: ASR ASR |
$1,372.04
|
| Rate for Payer: ASR Commercial |
$1,372.04
|
| Rate for Payer: BCBS Complete |
$856.60
|
| Rate for Payer: BCBS MAPPO |
$1,522.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.31
|
| Rate for Payer: BCN Commercial |
$1,096.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,522.03
|
| Rate for Payer: Cash Price |
$1,131.58
|
| Rate for Payer: Cash Price |
$1,131.58
|
| Rate for Payer: Cofinity Commercial |
$1,329.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,522.03
|
| Rate for Payer: Healthscope Commercial |
$1,414.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,372.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,522.03
|
| Rate for Payer: Mclaren Commercial |
$1,273.02
|
| Rate for Payer: Mclaren Medicaid |
$815.81
|
| Rate for Payer: Mclaren Medicare |
$1,522.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,598.13
|
| Rate for Payer: Meridian Medicaid |
$856.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,750.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.30
|
| Rate for Payer: Nomi Health Commercial |
$1,159.87
|
| Rate for Payer: PACE Medicare |
$1,445.93
|
| Rate for Payer: PACE SWMI |
$1,522.03
|
| Rate for Payer: PHP Commercial |
$1,674.23
|
| Rate for Payer: PHP Medicaid |
$815.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,522.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$815.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.15
|
| Rate for Payer: Priority Health Medicare |
$1,522.03
|
| Rate for Payer: Priority Health Narrow Network |
$377.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,522.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,244.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,522.03
|
| Rate for Payer: UHC Exchange |
$2,359.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.03
|
| Rate for Payer: UHCCP DNSP |
$1,522.03
|
| Rate for Payer: UHCCP Medicaid |
$815.81
|
| Rate for Payer: VA VA |
$1,522.03
|
|
|
HC THORACENT W TUBE
|
Facility
|
IP
|
$1,414.47
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$919.41 |
| Max. Negotiated Rate |
$1,414.47 |
| Rate for Payer: Aetna Commercial |
$1,273.02
|
| Rate for Payer: ASR ASR |
$1,372.04
|
| Rate for Payer: ASR Commercial |
$1,372.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.65
|
| Rate for Payer: BCN Commercial |
$1,096.64
|
| Rate for Payer: Cash Price |
$1,131.58
|
| Rate for Payer: Cofinity Commercial |
$1,329.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.58
|
| Rate for Payer: Healthscope Commercial |
$1,414.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,372.04
|
| Rate for Payer: Mclaren Commercial |
$1,273.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.30
|
| Rate for Payer: Nomi Health Commercial |
$1,159.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,244.73
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
IP
|
$704.90
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$458.18 |
| Max. Negotiated Rate |
$704.90 |
| Rate for Payer: Aetna Commercial |
$634.41
|
| Rate for Payer: ASR ASR |
$683.75
|
| Rate for Payer: ASR Commercial |
$683.75
|
| Rate for Payer: BCBS Trust/PPO |
$574.42
|
| Rate for Payer: BCN Commercial |
$546.51
|
| Rate for Payer: Cash Price |
$563.92
|
| Rate for Payer: Cofinity Commercial |
$662.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.92
|
| Rate for Payer: Healthscope Commercial |
$704.90
|
| Rate for Payer: Healthscope Whirlpool |
$683.75
|
| Rate for Payer: Mclaren Commercial |
$634.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.16
|
| Rate for Payer: Nomi Health Commercial |
$578.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.31
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
OP
|
$704.90
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$91.35 |
| Max. Negotiated Rate |
$704.90 |
| Rate for Payer: Aetna Commercial |
$634.41
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$683.75
|
| Rate for Payer: ASR Commercial |
$683.75
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$577.24
|
| Rate for Payer: BCN Commercial |
$546.51
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$563.92
|
| Rate for Payer: Cash Price |
$563.92
|
| Rate for Payer: Cofinity Commercial |
$662.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$704.90
|
| Rate for Payer: Healthscope Whirlpool |
$683.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$634.41
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.16
|
| Rate for Payer: Nomi Health Commercial |
$578.02
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.19
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$91.35
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC THORACOTOMY
|
Facility
|
IP
|
$2,091.88
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,359.72 |
| Max. Negotiated Rate |
$2,091.88 |
| Rate for Payer: Aetna Commercial |
$1,882.69
|
| Rate for Payer: ASR ASR |
$2,029.12
|
| Rate for Payer: ASR Commercial |
$2,029.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.67
|
| Rate for Payer: BCN Commercial |
$1,621.83
|
| Rate for Payer: Cash Price |
$1,673.50
|
| Rate for Payer: Cofinity Commercial |
$1,966.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,673.50
|
| Rate for Payer: Healthscope Commercial |
$2,091.88
|
| Rate for Payer: Healthscope Whirlpool |
$2,029.12
|
| Rate for Payer: Mclaren Commercial |
$1,882.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,778.10
|
| Rate for Payer: Nomi Health Commercial |
$1,715.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,840.85
|
|
|
HC THORACOTOMY
|
Facility
|
OP
|
$2,091.88
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$836.75 |
| Max. Negotiated Rate |
$2,091.88 |
| Rate for Payer: Aetna Commercial |
$1,882.69
|
| Rate for Payer: Aetna Medicare |
$1,045.94
|
| Rate for Payer: ASR ASR |
$2,029.12
|
| Rate for Payer: ASR Commercial |
$2,029.12
|
| Rate for Payer: BCBS Complete |
$836.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,713.04
|
| Rate for Payer: BCN Commercial |
$1,621.83
|
| Rate for Payer: Cash Price |
$1,673.50
|
| Rate for Payer: Cofinity Commercial |
$1,966.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,673.50
|
| Rate for Payer: Healthscope Commercial |
$2,091.88
|
| Rate for Payer: Healthscope Whirlpool |
$2,029.12
|
| Rate for Payer: Mclaren Commercial |
$1,882.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,778.10
|
| Rate for Payer: Nomi Health Commercial |
$1,715.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,832.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,466.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,840.85
|
|
|
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 |
$4,968.12 |
| Rate for Payer: Aetna Commercial |
$4,471.31
|
| Rate for Payer: ASR ASR |
$4,819.08
|
| Rate for Payer: ASR Commercial |
$4,819.08
|
| Rate for Payer: BCBS Trust/PPO |
$4,048.52
|
| Rate for Payer: BCN Commercial |
$3,851.78
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cofinity Commercial |
$4,670.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,974.50
|
| Rate for Payer: Healthscope Commercial |
$4,968.12
|
| Rate for Payer: Healthscope Whirlpool |
$4,819.08
|
| Rate for Payer: Mclaren Commercial |
$4,471.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,222.90
|
| Rate for Payer: Nomi Health Commercial |
$4,073.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,371.95
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
OP
|
$4,968.12
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,987.25 |
| Max. Negotiated Rate |
$4,968.12 |
| Rate for Payer: Aetna Commercial |
$4,471.31
|
| Rate for Payer: Aetna Medicare |
$2,484.06
|
| Rate for Payer: ASR ASR |
$4,819.08
|
| Rate for Payer: ASR Commercial |
$4,819.08
|
| Rate for Payer: BCBS Complete |
$1,987.25
|
| Rate for Payer: BCBS Trust/PPO |
$4,068.39
|
| Rate for Payer: BCN Commercial |
$3,851.78
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cofinity Commercial |
$4,670.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,974.50
|
| Rate for Payer: Healthscope Commercial |
$4,968.12
|
| Rate for Payer: Healthscope Whirlpool |
$4,819.08
|
| Rate for Payer: Mclaren Commercial |
$4,471.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,222.90
|
| Rate for Payer: Nomi Health Commercial |
$4,073.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,353.07
|
| Rate for Payer: Priority Health Narrow Network |
$3,482.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,371.95
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| 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 |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: BCBS MAPPO |
$5.77
|
| Rate for Payer: BCBS Trust/PPO |
$62.20
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: BCN Medicare Advantage |
$5.77
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.77
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.77
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| Rate for Payer: Mclaren Medicare |
$5.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.06
|
| Rate for Payer: Meridian Medicaid |
$3.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| 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 |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.55
|
| Rate for Payer: Priority Health Medicare |
$5.77
|
| Rate for Payer: Priority Health Narrow Network |
$53.24
|
| Rate for Payer: Railroad Medicare Medicare |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.77
|
| Rate for Payer: UHC Exchange |
$8.94
|
| Rate for Payer: UHC Medicare Advantage |
$5.77
|
| Rate for Payer: UHCCP DNSP |
$5.77
|
| Rate for Payer: UHCCP Medicaid |
$3.09
|
| Rate for Payer: VA VA |
$5.77
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: ASR ASR |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Trust/PPO |
$61.89
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
OP
|
$104.99
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$104.99 |
| Rate for Payer: Aetna Commercial |
$94.49
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: ASR ASR |
$101.84
|
| Rate for Payer: ASR Commercial |
$101.84
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS Trust/PPO |
$85.98
|
| Rate for Payer: BCN Commercial |
$81.40
|
| 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 |
$104.99
|
| Rate for Payer: Healthscope Whirlpool |
$101.84
|
| 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: Priority Health Cigna Priority Health |
$68.24
|
| Rate for Payer: 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 |
$68.24 |
| Max. Negotiated Rate |
$104.99 |
| Rate for Payer: Aetna Commercial |
$94.49
|
| Rate for Payer: ASR ASR |
$101.84
|
| Rate for Payer: ASR Commercial |
$101.84
|
| Rate for Payer: BCBS Trust/PPO |
$85.56
|
| Rate for Payer: BCN Commercial |
$81.40
|
| 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 |
$104.99
|
| Rate for Payer: Healthscope Whirlpool |
$101.84
|
| 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: Priority Health Cigna Priority Health |
$68.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.39
|
|
|
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 |
$1,044.23 |
| Rate for Payer: Aetna Commercial |
$939.81
|
| Rate for Payer: ASR ASR |
$1,012.90
|
| Rate for Payer: ASR Commercial |
$1,012.90
|
| Rate for Payer: BCBS Trust/PPO |
$850.94
|
| Rate for Payer: BCN Commercial |
$809.59
|
| 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 |
$1,044.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,012.90
|
| 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: Priority Health Cigna Priority Health |
$678.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$918.92
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
OP
|
$1,044.23
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$417.69 |
| Max. Negotiated Rate |
$1,044.23 |
| Rate for Payer: Aetna Commercial |
$939.81
|
| Rate for Payer: Aetna Medicare |
$522.12
|
| Rate for Payer: ASR ASR |
$1,012.90
|
| Rate for Payer: ASR Commercial |
$1,012.90
|
| Rate for Payer: BCBS Complete |
$417.69
|
| Rate for Payer: BCBS Trust/PPO |
$855.12
|
| Rate for Payer: BCN Commercial |
$809.59
|
| 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 |
$1,044.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,012.90
|
| 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: Priority Health Cigna Priority Health |
$678.75
|
| Rate for Payer: 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 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 |
$1,365.80 |
| Rate for Payer: Aetna Commercial |
$1,229.22
|
| Rate for Payer: ASR ASR |
$1,324.83
|
| Rate for Payer: ASR Commercial |
$1,324.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,112.99
|
| Rate for Payer: BCN Commercial |
$1,058.90
|
| 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 |
$1,365.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,324.83
|
| 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: Priority Health Cigna Priority Health |
$887.77
|
| 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 |
$546.32 |
| Max. Negotiated Rate |
$1,365.80 |
| Rate for Payer: Aetna Commercial |
$1,229.22
|
| Rate for Payer: Aetna Medicare |
$682.90
|
| Rate for Payer: ASR ASR |
$1,324.83
|
| Rate for Payer: ASR Commercial |
$1,324.83
|
| Rate for Payer: BCBS Complete |
$546.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.45
|
| Rate for Payer: BCN Commercial |
$1,058.90
|
| 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 |
$1,365.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,324.83
|
| 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: Priority Health Cigna Priority Health |
$887.77
|
| Rate for Payer: 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
|
IP
|
$1,485.84
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$965.80 |
| Max. Negotiated Rate |
$1,485.84 |
| Rate for Payer: Aetna Commercial |
$1,337.26
|
| Rate for Payer: ASR ASR |
$1,441.26
|
| Rate for Payer: ASR Commercial |
$1,441.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,210.81
|
| Rate for Payer: BCN Commercial |
$1,151.97
|
| 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 |
$1,485.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,441.26
|
| 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: Priority Health Cigna Priority Health |
$965.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,307.54
|
|
|
HC THROMBO EMBO CATHETER LVL 14
|
Facility
|
OP
|
$1,485.84
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$594.34 |
| Max. Negotiated Rate |
$1,485.84 |
| Rate for Payer: Aetna Commercial |
$1,337.26
|
| Rate for Payer: Aetna Medicare |
$742.92
|
| Rate for Payer: ASR ASR |
$1,441.26
|
| Rate for Payer: ASR Commercial |
$1,441.26
|
| Rate for Payer: BCBS Complete |
$594.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,216.75
|
| Rate for Payer: BCN Commercial |
$1,151.97
|
| 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 |
$1,485.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,441.26
|
| 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: Priority Health Cigna Priority Health |
$965.80
|
| Rate for Payer: 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 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 |
$3,368.04 |
| Rate for Payer: Aetna Commercial |
$3,031.24
|
| Rate for Payer: ASR ASR |
$3,267.00
|
| Rate for Payer: ASR Commercial |
$3,267.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,744.62
|
| Rate for Payer: BCN Commercial |
$2,611.24
|
| 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 |
$3,368.04
|
| Rate for Payer: Healthscope Whirlpool |
$3,267.00
|
| 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: Priority Health Cigna Priority Health |
$2,189.23
|
| 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 |
$1,347.22 |
| Max. Negotiated Rate |
$3,368.04 |
| Rate for Payer: Aetna Commercial |
$3,031.24
|
| Rate for Payer: Aetna Medicare |
$1,684.02
|
| Rate for Payer: ASR ASR |
$3,267.00
|
| Rate for Payer: ASR Commercial |
$3,267.00
|
| Rate for Payer: BCBS Complete |
$1,347.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,758.09
|
| Rate for Payer: BCN Commercial |
$2,611.24
|
| 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 |
$3,368.04
|
| Rate for Payer: Healthscope Whirlpool |
$3,267.00
|
| 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: Priority Health Cigna Priority Health |
$2,189.23
|
| Rate for Payer: 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 |
$1,844.00 |
| Max. Negotiated Rate |
$4,610.00 |
| Rate for Payer: Aetna Commercial |
$4,149.00
|
| Rate for Payer: Aetna Medicare |
$2,305.00
|
| Rate for Payer: ASR ASR |
$4,471.70
|
| Rate for Payer: ASR Commercial |
$4,471.70
|
| Rate for Payer: BCBS Complete |
$1,844.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,775.13
|
| 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 Commercial |
$3,918.50
|
| Rate for Payer: Nomi Health Commercial |
$3,780.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,996.50
|
| Rate for Payer: 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 |
$2,996.50 |
| 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: ASR Commercial |
$4,471.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,756.69
|
| 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 Commercial |
$3,918.50
|
| Rate for Payer: Nomi Health Commercial |
$3,780.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,996.50
|
| 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: Aetna Medicare |
$3,572.58
|
| Rate for Payer: ASR ASR |
$6,930.80
|
| Rate for Payer: ASR Commercial |
$6,930.80
|
| Rate for Payer: BCBS Complete |
$2,858.06
|
| Rate for Payer: BCBS Trust/PPO |
$5,851.16
|
| 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 Commercial |
$6,073.38
|
| Rate for Payer: Nomi Health Commercial |
$5,859.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,644.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,260.58
|
| Rate for Payer: Priority Health Narrow Network |
$5,008.75
|
| 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 |
$4,644.35 |
| 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: ASR Commercial |
$6,930.80
|
| Rate for Payer: BCBS Trust/PPO |
$5,822.58
|
| 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 Commercial |
$6,073.38
|
| Rate for Payer: Nomi Health Commercial |
$5,859.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,644.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,287.73
|
|
