|
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 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 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 |
$52.49
|
| 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 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 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 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
|
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 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 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 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 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
|
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
|
|
|
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 |
$3,572.57
|
| 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 88
|
Facility
|
OP
|
$8,810.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,524.00 |
| Max. Negotiated Rate |
$8,810.00 |
| Rate for Payer: Aetna Commercial |
$7,929.00
|
| Rate for Payer: Aetna Medicare |
$4,405.00
|
| Rate for Payer: ASR ASR |
$8,545.70
|
| Rate for Payer: ASR Commercial |
$8,545.70
|
| Rate for Payer: BCBS Complete |
$3,524.00
|
| Rate for Payer: BCBS Trust/PPO |
$7,214.51
|
| Rate for Payer: BCN Commercial |
$6,830.39
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Commercial |
$8,281.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,048.00
|
| Rate for Payer: Healthscope Commercial |
$8,810.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,545.70
|
| Rate for Payer: Mclaren Commercial |
$7,929.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: Nomi Health Commercial |
$7,224.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,726.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,719.32
|
| Rate for Payer: Priority Health Narrow Network |
$6,175.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,752.80
|
|
|
HC THROMBO EMBO CATHETER LVL 88
|
Facility
|
IP
|
$8,810.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,726.50 |
| Max. Negotiated Rate |
$8,810.00 |
| Rate for Payer: Aetna Commercial |
$7,929.00
|
| Rate for Payer: ASR ASR |
$8,545.70
|
| Rate for Payer: ASR Commercial |
$8,545.70
|
| Rate for Payer: BCBS Trust/PPO |
$7,179.27
|
| Rate for Payer: BCN Commercial |
$6,830.39
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Commercial |
$8,281.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,048.00
|
| Rate for Payer: Healthscope Commercial |
$8,810.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,545.70
|
| Rate for Payer: Mclaren Commercial |
$7,929.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: Nomi Health Commercial |
$7,224.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,726.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,752.80
|
|
|
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: Aetna Medicare |
$7,079.93
|
| Rate for Payer: ASR ASR |
$13,735.05
|
| Rate for Payer: ASR Commercial |
$13,735.05
|
| Rate for Payer: BCBS Complete |
$5,663.94
|
| Rate for Payer: BCBS Trust/PPO |
$11,595.50
|
| 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 Commercial |
$12,035.87
|
| Rate for Payer: Nomi Health Commercial |
$11,611.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,203.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,406.86
|
| Rate for Payer: Priority Health Narrow Network |
$9,926.05
|
| 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 |
$9,203.90 |
| 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: ASR Commercial |
$13,735.05
|
| Rate for Payer: BCBS Trust/PPO |
$11,538.86
|
| 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 Commercial |
$12,035.87
|
| Rate for Payer: Nomi Health Commercial |
$11,611.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,203.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,460.67
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
OP
|
$519.80
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.39 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$467.82
|
| Rate for Payer: Aetna Medicare |
$323.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: ASR ASR |
$504.21
|
| Rate for Payer: ASR Commercial |
$504.21
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCBS Trust/PPO |
$425.66
|
| Rate for Payer: BCN Commercial |
$403.00
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cofinity Commercial |
$488.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.49
|
| Rate for Payer: Healthscope Commercial |
$519.80
|
| Rate for Payer: Healthscope Whirlpool |
$504.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$323.49
|
| Rate for Payer: Mclaren Commercial |
$467.82
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.83
|
| Rate for Payer: Nomi Health Commercial |
$426.24
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: PHP Medicaid |
$173.39
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.45
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Priority Health Narrow Network |
$364.38
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Exchange |
$501.41
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP DNSP |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$173.39
|
| Rate for Payer: VA VA |
$323.49
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
IP
|
$519.80
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.87 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$467.82
|
| Rate for Payer: ASR ASR |
$504.21
|
| Rate for Payer: ASR Commercial |
$504.21
|
| Rate for Payer: BCBS Trust/PPO |
$423.59
|
| Rate for Payer: BCN Commercial |
$403.00
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cofinity Commercial |
$488.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.84
|
| Rate for Payer: Healthscope Commercial |
$519.80
|
| Rate for Payer: Healthscope Whirlpool |
$504.21
|
| Rate for Payer: Mclaren Commercial |
$467.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.83
|
| Rate for Payer: Nomi Health Commercial |
$426.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.42
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
OP
|
$4,644.53
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$4,180.08
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$4,505.19
|
| Rate for Payer: ASR Commercial |
$4,505.19
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,803.41
|
| Rate for Payer: BCN Commercial |
$3,600.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$3,715.62
|
| Rate for Payer: Cash Price |
$3,715.62
|
| Rate for Payer: Cofinity Commercial |
$4,365.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,715.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$4,644.53
|
| Rate for Payer: Healthscope Whirlpool |
$4,505.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$4,180.08
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,947.85
|
| Rate for Payer: Nomi Health Commercial |
$3,808.51
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,018.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,069.54
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$3,255.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,087.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
IP
|
$4,644.53
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,018.94 |
| Max. Negotiated Rate |
$4,644.53 |
| Rate for Payer: Aetna Commercial |
$4,180.08
|
| Rate for Payer: ASR ASR |
$4,505.19
|
| Rate for Payer: ASR Commercial |
$4,505.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,784.83
|
| Rate for Payer: BCN Commercial |
$3,600.90
|
| Rate for Payer: Cash Price |
$3,715.62
|
| Rate for Payer: Cofinity Commercial |
$4,365.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,715.62
|
| Rate for Payer: Healthscope Commercial |
$4,644.53
|
| Rate for Payer: Healthscope Whirlpool |
$4,505.19
|
| Rate for Payer: Mclaren Commercial |
$4,180.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,947.85
|
| Rate for Payer: Nomi Health Commercial |
$3,808.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,018.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,087.19
|
|
|
HC THSD7
|
Facility
|
IP
|
$380.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$247.23 |
| Max. Negotiated Rate |
$380.36 |
| Rate for Payer: Aetna Commercial |
$342.32
|
| Rate for Payer: ASR ASR |
$368.95
|
| Rate for Payer: ASR Commercial |
$368.95
|
| Rate for Payer: BCBS Trust/PPO |
$309.96
|
| Rate for Payer: BCN Commercial |
$294.89
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cofinity Commercial |
$357.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Healthscope Commercial |
$380.36
|
| Rate for Payer: Healthscope Whirlpool |
$368.95
|
| Rate for Payer: Mclaren Commercial |
$342.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: Nomi Health Commercial |
$311.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.72
|
|
|
HC THSD7
|
Facility
|
OP
|
$380.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$380.36 |
| Rate for Payer: Aetna Commercial |
$342.32
|
| 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 |
$368.95
|
| Rate for Payer: ASR Commercial |
$368.95
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$311.48
|
| Rate for Payer: BCN Commercial |
$294.89
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cofinity Commercial |
$357.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$380.36
|
| Rate for Payer: Healthscope Whirlpool |
$368.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$342.32
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: Nomi Health Commercial |
$311.90
|
| 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 |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.27
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$266.63
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
