|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING
|
Facility
|
OP
|
$18,905.74
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
36100527
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,333.08 |
| Max. Negotiated Rate |
$17,015.17 |
| Rate for Payer: Aetna Commercial |
$16,069.88
|
| Rate for Payer: Aetna Medicare |
$4,915.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,908.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,908.04
|
| Rate for Payer: BCBS Complete |
$3,499.45
|
| Rate for Payer: BCBS MAPPO |
$4,726.44
|
| Rate for Payer: BCBS Trust/PPO |
$15,542.41
|
| Rate for Payer: BCN Commercial |
$15,542.41
|
| Rate for Payer: BCN Medicare Advantage |
$4,726.44
|
| Rate for Payer: Cash Price |
$15,124.59
|
| Rate for Payer: Cofinity Commercial |
$16,258.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,124.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,726.44
|
| Rate for Payer: Healthscope Commercial |
$17,015.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,179.31
|
| Rate for Payer: Mclaren Medicaid |
$3,333.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,962.76
|
| Rate for Payer: Meridian Medicaid |
$3,499.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,435.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,069.88
|
| Rate for Payer: Nomi Health Commercial |
$15,502.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,179.31
|
| Rate for Payer: PACE Senior Care Partners |
$4,490.11
|
| Rate for Payer: PACE SWMI |
$4,726.44
|
| Rate for Payer: PHP Commercial |
$16,069.88
|
| Rate for Payer: PHP Medicare Advantage |
$4,726.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,333.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16,447.99
|
| Rate for Payer: Priority Health Medicare |
$4,773.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,158.40
|
| Rate for Payer: Railroad Medicare Medicare |
$4,726.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,637.05
|
| Rate for Payer: UHC Core |
$15,786.29
|
| Rate for Payer: UHC Exchange |
$4,726.44
|
| Rate for Payer: UHC Medicaid |
$3,333.08
|
| Rate for Payer: UHC Medicare Advantage |
$4,726.44
|
| Rate for Payer: UHCCP Medicaid |
$3,333.08
|
| Rate for Payer: VA VA |
$4,726.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,179.31
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING
|
Facility
|
IP
|
$18,905.74
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
36100527
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,158.40 |
| Max. Negotiated Rate |
$17,015.17 |
| Rate for Payer: Aetna Commercial |
$16,069.88
|
| Rate for Payer: BCBS Trust/PPO |
$15,614.25
|
| Rate for Payer: BCN Commercial |
$15,614.25
|
| Rate for Payer: Cash Price |
$15,124.59
|
| Rate for Payer: Cofinity Commercial |
$16,258.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,124.59
|
| Rate for Payer: Healthscope Commercial |
$17,015.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,179.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,069.88
|
| Rate for Payer: Nomi Health Commercial |
$15,502.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,179.31
|
| Rate for Payer: PHP Commercial |
$16,069.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16,447.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,158.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,637.05
|
| Rate for Payer: UHC Core |
$15,786.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,179.31
|
|
|
HC DIALYSIS CATH LVL 10 LONG TERM
|
Facility
|
OP
|
$1,047.44
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.66 |
| Max. Negotiated Rate |
$942.70 |
| Rate for Payer: Aetna Commercial |
$890.32
|
| Rate for Payer: Aetna Medicare |
$272.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$327.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$327.32
|
| Rate for Payer: BCBS Complete |
$193.88
|
| Rate for Payer: BCBS MAPPO |
$261.86
|
| Rate for Payer: BCBS Trust/PPO |
$861.10
|
| Rate for Payer: BCN Commercial |
$861.10
|
| Rate for Payer: BCN Medicare Advantage |
$261.86
|
| Rate for Payer: Cash Price |
$837.95
|
| Rate for Payer: Cofinity Commercial |
$900.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$837.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$261.86
|
| Rate for Payer: Healthscope Commercial |
$942.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$785.58
|
| Rate for Payer: Mclaren Medicaid |
$184.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$274.95
|
| Rate for Payer: Meridian Medicaid |
$193.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$301.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$288.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.32
|
| Rate for Payer: Nomi Health Commercial |
$858.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$785.58
|
| Rate for Payer: PACE Senior Care Partners |
$248.77
|
| Rate for Payer: PACE SWMI |
$261.86
|
| Rate for Payer: PHP Commercial |
$890.32
|
| Rate for Payer: PHP Medicare Advantage |
$261.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$911.27
|
| Rate for Payer: Priority Health Medicare |
$264.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$729.02
|
| Rate for Payer: Railroad Medicare Medicare |
$261.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$921.75
|
| Rate for Payer: UHC Core |
$874.61
|
| Rate for Payer: UHC Exchange |
$261.86
|
| Rate for Payer: UHC Medicaid |
$184.66
|
| Rate for Payer: UHC Medicare Advantage |
$261.86
|
| Rate for Payer: UHCCP Medicaid |
$184.66
|
| Rate for Payer: VA VA |
$261.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$785.58
|
|
|
HC DIALYSIS CATH LVL 10 LONG TERM
|
Facility
|
IP
|
$1,047.44
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.02 |
| Max. Negotiated Rate |
$942.70 |
| Rate for Payer: Aetna Commercial |
$890.32
|
| Rate for Payer: BCBS Trust/PPO |
$865.08
|
| Rate for Payer: BCN Commercial |
$865.08
|
| Rate for Payer: Cash Price |
$837.95
|
| Rate for Payer: Cofinity Commercial |
$900.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$837.95
|
| Rate for Payer: Healthscope Commercial |
$942.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$785.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.32
|
| Rate for Payer: Nomi Health Commercial |
$858.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$785.58
|
| Rate for Payer: PHP Commercial |
$890.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$911.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$729.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$921.75
|
| Rate for Payer: UHC Core |
$874.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$785.58
|
|
|
HC DIALYSIS CATH LVL 11 LONG TERM
|
Facility
|
OP
|
$1,171.97
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.62 |
| Max. Negotiated Rate |
$1,054.77 |
| Rate for Payer: Aetna Commercial |
$996.17
|
| Rate for Payer: Aetna Medicare |
$304.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$366.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$366.24
|
| Rate for Payer: BCBS Complete |
$216.93
|
| Rate for Payer: BCBS MAPPO |
$292.99
|
| Rate for Payer: BCBS Trust/PPO |
$963.48
|
| Rate for Payer: BCN Commercial |
$963.48
|
| Rate for Payer: BCN Medicare Advantage |
$292.99
|
| Rate for Payer: Cash Price |
$937.58
|
| Rate for Payer: Cofinity Commercial |
$1,007.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.99
|
| Rate for Payer: Healthscope Commercial |
$1,054.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$878.98
|
| Rate for Payer: Mclaren Medicaid |
$206.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.64
|
| Rate for Payer: Meridian Medicaid |
$216.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$322.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.17
|
| Rate for Payer: Nomi Health Commercial |
$961.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$878.98
|
| Rate for Payer: PACE Senior Care Partners |
$278.34
|
| Rate for Payer: PACE SWMI |
$292.99
|
| Rate for Payer: PHP Commercial |
$996.17
|
| Rate for Payer: PHP Medicare Advantage |
$292.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$206.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,019.61
|
| Rate for Payer: Priority Health Medicare |
$295.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$815.69
|
| Rate for Payer: Railroad Medicare Medicare |
$292.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,031.33
|
| Rate for Payer: UHC Core |
$978.59
|
| Rate for Payer: UHC Exchange |
$292.99
|
| Rate for Payer: UHC Medicaid |
$206.62
|
| Rate for Payer: UHC Medicare Advantage |
$292.99
|
| Rate for Payer: UHCCP Medicaid |
$206.62
|
| Rate for Payer: VA VA |
$292.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$878.98
|
|
|
HC DIALYSIS CATH LVL 11 LONG TERM
|
Facility
|
IP
|
$1,171.97
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.69 |
| Max. Negotiated Rate |
$1,054.77 |
| Rate for Payer: Aetna Commercial |
$996.17
|
| Rate for Payer: BCBS Trust/PPO |
$967.93
|
| Rate for Payer: BCN Commercial |
$967.93
|
| Rate for Payer: Cash Price |
$937.58
|
| Rate for Payer: Cofinity Commercial |
$1,007.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.58
|
| Rate for Payer: Healthscope Commercial |
$1,054.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$878.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.17
|
| Rate for Payer: Nomi Health Commercial |
$961.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$878.98
|
| Rate for Payer: PHP Commercial |
$996.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,019.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$815.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,031.33
|
| Rate for Payer: UHC Core |
$978.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$878.98
|
|
|
HC DIALYSIS CATH LVL 13 LONG TERM
|
Facility
|
OP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.30 |
| Max. Negotiated Rate |
$1,242.05 |
| Rate for Payer: Aetna Commercial |
$1,173.05
|
| Rate for Payer: Aetna Medicare |
$358.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$431.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$431.27
|
| Rate for Payer: BCBS Complete |
$255.45
|
| Rate for Payer: BCBS MAPPO |
$345.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.55
|
| Rate for Payer: BCN Commercial |
$1,134.55
|
| Rate for Payer: BCN Medicare Advantage |
$345.01
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,186.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.01
|
| Rate for Payer: Healthscope Commercial |
$1,242.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.05
|
| Rate for Payer: Mclaren Medicaid |
$243.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.27
|
| Rate for Payer: Meridian Medicaid |
$255.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$379.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Nomi Health Commercial |
$1,131.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.05
|
| Rate for Payer: PACE Senior Care Partners |
$327.76
|
| Rate for Payer: PACE SWMI |
$345.01
|
| Rate for Payer: PHP Commercial |
$1,173.05
|
| Rate for Payer: PHP Medicare Advantage |
$345.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$243.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,200.65
|
| Rate for Payer: Priority Health Medicare |
$348.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$960.52
|
| Rate for Payer: Railroad Medicare Medicare |
$345.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,214.45
|
| Rate for Payer: UHC Core |
$1,152.35
|
| Rate for Payer: UHC Exchange |
$345.01
|
| Rate for Payer: UHC Medicaid |
$243.30
|
| Rate for Payer: UHC Medicare Advantage |
$345.01
|
| Rate for Payer: UHCCP Medicaid |
$243.30
|
| Rate for Payer: VA VA |
$345.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.05
|
|
|
HC DIALYSIS CATH LVL 13 LONG TERM
|
Facility
|
IP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$960.52 |
| Max. Negotiated Rate |
$1,242.05 |
| Rate for Payer: Aetna Commercial |
$1,173.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.79
|
| Rate for Payer: BCN Commercial |
$1,139.79
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,186.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,242.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Nomi Health Commercial |
$1,131.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.05
|
| Rate for Payer: PHP Commercial |
$1,173.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,200.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$960.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,214.45
|
| Rate for Payer: UHC Core |
$1,152.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.05
|
|
|
HC DIALYSIS CATH LVL 2 SHORT TERM
|
Facility
|
OP
|
$208.07
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.68 |
| Max. Negotiated Rate |
$187.26 |
| Rate for Payer: Aetna Commercial |
$176.86
|
| Rate for Payer: Aetna Medicare |
$54.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.02
|
| Rate for Payer: BCBS Complete |
$38.51
|
| Rate for Payer: BCBS MAPPO |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$171.05
|
| Rate for Payer: BCN Commercial |
$171.05
|
| Rate for Payer: BCN Medicare Advantage |
$52.02
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$178.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.02
|
| Rate for Payer: Healthscope Commercial |
$187.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.05
|
| Rate for Payer: Mclaren Medicaid |
$36.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.62
|
| Rate for Payer: Meridian Medicaid |
$38.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.86
|
| Rate for Payer: Nomi Health Commercial |
$170.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.05
|
| Rate for Payer: PACE Senior Care Partners |
$49.42
|
| Rate for Payer: PACE SWMI |
$52.02
|
| Rate for Payer: PHP Commercial |
$176.86
|
| Rate for Payer: PHP Medicare Advantage |
$52.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.02
|
| Rate for Payer: Priority Health Medicare |
$52.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.82
|
| Rate for Payer: Railroad Medicare Medicare |
$52.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.10
|
| Rate for Payer: UHC Core |
$173.74
|
| Rate for Payer: UHC Exchange |
$52.02
|
| Rate for Payer: UHC Medicaid |
$36.68
|
| Rate for Payer: UHC Medicare Advantage |
$52.02
|
| Rate for Payer: UHCCP Medicaid |
$36.68
|
| Rate for Payer: VA VA |
$52.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.05
|
|
|
HC DIALYSIS CATH LVL 2 SHORT TERM
|
Facility
|
IP
|
$208.07
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.82 |
| Max. Negotiated Rate |
$187.26 |
| Rate for Payer: Aetna Commercial |
$176.86
|
| Rate for Payer: BCBS Trust/PPO |
$171.85
|
| Rate for Payer: BCN Commercial |
$171.85
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$178.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$187.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.86
|
| Rate for Payer: Nomi Health Commercial |
$170.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.05
|
| Rate for Payer: PHP Commercial |
$176.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.10
|
| Rate for Payer: UHC Core |
$173.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.05
|
|
|
HC DIALYSIS CATH LVL 3 SHORT TERM
|
Facility
|
IP
|
$315.17
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.36 |
| Max. Negotiated Rate |
$283.65 |
| Rate for Payer: Aetna Commercial |
$267.89
|
| Rate for Payer: BCBS Trust/PPO |
$260.30
|
| Rate for Payer: BCN Commercial |
$260.30
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cofinity Commercial |
$271.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.14
|
| Rate for Payer: Healthscope Commercial |
$283.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: Nomi Health Commercial |
$258.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.38
|
| Rate for Payer: PHP Commercial |
$267.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$274.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.35
|
| Rate for Payer: UHC Core |
$263.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.38
|
|
|
HC DIALYSIS CATH LVL 3 SHORT TERM
|
Facility
|
OP
|
$315.17
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.56 |
| Max. Negotiated Rate |
$283.65 |
| Rate for Payer: Aetna Commercial |
$267.89
|
| Rate for Payer: Aetna Medicare |
$81.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.49
|
| Rate for Payer: BCBS Complete |
$58.34
|
| Rate for Payer: BCBS MAPPO |
$78.79
|
| Rate for Payer: BCBS Trust/PPO |
$259.10
|
| Rate for Payer: BCN Commercial |
$259.10
|
| Rate for Payer: BCN Medicare Advantage |
$78.79
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cofinity Commercial |
$271.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.79
|
| Rate for Payer: Healthscope Commercial |
$283.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.38
|
| Rate for Payer: Mclaren Medicaid |
$55.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.73
|
| Rate for Payer: Meridian Medicaid |
$58.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: Nomi Health Commercial |
$258.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.38
|
| Rate for Payer: PACE Senior Care Partners |
$74.85
|
| Rate for Payer: PACE SWMI |
$78.79
|
| Rate for Payer: PHP Commercial |
$267.89
|
| Rate for Payer: PHP Medicare Advantage |
$78.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$274.20
|
| Rate for Payer: Priority Health Medicare |
$79.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.36
|
| Rate for Payer: Railroad Medicare Medicare |
$78.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.35
|
| Rate for Payer: UHC Core |
$263.17
|
| Rate for Payer: UHC Exchange |
$78.79
|
| Rate for Payer: UHC Medicaid |
$55.56
|
| Rate for Payer: UHC Medicare Advantage |
$78.79
|
| Rate for Payer: UHCCP Medicaid |
$55.56
|
| Rate for Payer: VA VA |
$78.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.38
|
|
|
HC DIALYSIS CATH LVL 4 SHORT TERM
|
Facility
|
IP
|
$422.27
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.90 |
| Max. Negotiated Rate |
$380.04 |
| Rate for Payer: Aetna Commercial |
$358.93
|
| Rate for Payer: BCBS Trust/PPO |
$348.75
|
| Rate for Payer: BCN Commercial |
$348.75
|
| Rate for Payer: Cash Price |
$337.82
|
| Rate for Payer: Cofinity Commercial |
$363.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.82
|
| Rate for Payer: Healthscope Commercial |
$380.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.93
|
| Rate for Payer: Nomi Health Commercial |
$346.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.70
|
| Rate for Payer: PHP Commercial |
$358.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$367.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.60
|
| Rate for Payer: UHC Core |
$352.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.70
|
|
|
HC DIALYSIS CATH LVL 4 SHORT TERM
|
Facility
|
OP
|
$422.27
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.45 |
| Max. Negotiated Rate |
$380.04 |
| Rate for Payer: Aetna Commercial |
$358.93
|
| Rate for Payer: Aetna Medicare |
$109.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.96
|
| Rate for Payer: BCBS Complete |
$78.16
|
| Rate for Payer: BCBS MAPPO |
$105.57
|
| Rate for Payer: BCBS Trust/PPO |
$347.15
|
| Rate for Payer: BCN Commercial |
$347.15
|
| Rate for Payer: BCN Medicare Advantage |
$105.57
|
| Rate for Payer: Cash Price |
$337.82
|
| Rate for Payer: Cofinity Commercial |
$363.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.57
|
| Rate for Payer: Healthscope Commercial |
$380.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.70
|
| Rate for Payer: Mclaren Medicaid |
$74.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.85
|
| Rate for Payer: Meridian Medicaid |
$78.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.93
|
| Rate for Payer: Nomi Health Commercial |
$346.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.70
|
| Rate for Payer: PACE Senior Care Partners |
$100.29
|
| Rate for Payer: PACE SWMI |
$105.57
|
| Rate for Payer: PHP Commercial |
$358.93
|
| Rate for Payer: PHP Medicare Advantage |
$105.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$367.37
|
| Rate for Payer: Priority Health Medicare |
$106.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.90
|
| Rate for Payer: Railroad Medicare Medicare |
$105.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.60
|
| Rate for Payer: UHC Core |
$352.60
|
| Rate for Payer: UHC Exchange |
$105.57
|
| Rate for Payer: UHC Medicaid |
$74.45
|
| Rate for Payer: UHC Medicare Advantage |
$105.57
|
| Rate for Payer: UHCCP Medicaid |
$74.45
|
| Rate for Payer: VA VA |
$105.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.70
|
|
|
HC DIALYSIS CATH LVL 5 SHORT TERM
|
Facility
|
IP
|
$529.37
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.44 |
| Max. Negotiated Rate |
$476.43 |
| Rate for Payer: Aetna Commercial |
$449.96
|
| Rate for Payer: BCBS Trust/PPO |
$437.21
|
| Rate for Payer: BCN Commercial |
$437.21
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cofinity Commercial |
$455.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.50
|
| Rate for Payer: Healthscope Commercial |
$476.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.96
|
| Rate for Payer: Nomi Health Commercial |
$434.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.03
|
| Rate for Payer: PHP Commercial |
$449.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$460.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$368.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.85
|
| Rate for Payer: UHC Core |
$442.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.03
|
|
|
HC DIALYSIS CATH LVL 5 SHORT TERM
|
Facility
|
OP
|
$529.37
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.33 |
| Max. Negotiated Rate |
$476.43 |
| Rate for Payer: Aetna Commercial |
$449.96
|
| Rate for Payer: Aetna Medicare |
$137.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.43
|
| Rate for Payer: BCBS Complete |
$97.99
|
| Rate for Payer: BCBS MAPPO |
$132.34
|
| Rate for Payer: BCBS Trust/PPO |
$435.20
|
| Rate for Payer: BCN Commercial |
$435.20
|
| Rate for Payer: BCN Medicare Advantage |
$132.34
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cofinity Commercial |
$455.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.34
|
| Rate for Payer: Healthscope Commercial |
$476.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.03
|
| Rate for Payer: Mclaren Medicaid |
$93.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.96
|
| Rate for Payer: Meridian Medicaid |
$97.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.96
|
| Rate for Payer: Nomi Health Commercial |
$434.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.03
|
| Rate for Payer: PACE Senior Care Partners |
$125.73
|
| Rate for Payer: PACE SWMI |
$132.34
|
| Rate for Payer: PHP Commercial |
$449.96
|
| Rate for Payer: PHP Medicare Advantage |
$132.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$460.55
|
| Rate for Payer: Priority Health Medicare |
$133.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$368.44
|
| Rate for Payer: Railroad Medicare Medicare |
$132.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.85
|
| Rate for Payer: UHC Core |
$442.02
|
| Rate for Payer: UHC Exchange |
$132.34
|
| Rate for Payer: UHC Medicaid |
$93.33
|
| Rate for Payer: UHC Medicare Advantage |
$132.34
|
| Rate for Payer: UHCCP Medicaid |
$93.33
|
| Rate for Payer: VA VA |
$132.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.03
|
|
|
HC DIALYSIS CATH LVL 7 LONG TERM
|
Facility
|
OP
|
$743.57
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
27200319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.09 |
| Max. Negotiated Rate |
$669.21 |
| Rate for Payer: Aetna Commercial |
$632.03
|
| Rate for Payer: Aetna Medicare |
$193.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$232.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$232.37
|
| Rate for Payer: BCBS Complete |
$137.63
|
| Rate for Payer: BCBS MAPPO |
$185.89
|
| Rate for Payer: BCBS Trust/PPO |
$611.29
|
| Rate for Payer: BCN Commercial |
$611.29
|
| Rate for Payer: BCN Medicare Advantage |
$185.89
|
| Rate for Payer: Cash Price |
$594.86
|
| Rate for Payer: Cofinity Commercial |
$639.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.89
|
| Rate for Payer: Healthscope Commercial |
$669.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.68
|
| Rate for Payer: Mclaren Medicaid |
$131.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.19
|
| Rate for Payer: Meridian Medicaid |
$137.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$204.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.03
|
| Rate for Payer: Nomi Health Commercial |
$609.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.68
|
| Rate for Payer: PACE Senior Care Partners |
$176.60
|
| Rate for Payer: PACE SWMI |
$185.89
|
| Rate for Payer: PHP Commercial |
$632.03
|
| Rate for Payer: PHP Medicare Advantage |
$185.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$646.91
|
| Rate for Payer: Priority Health Medicare |
$187.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$517.52
|
| Rate for Payer: Railroad Medicare Medicare |
$185.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.34
|
| Rate for Payer: UHC Core |
$620.88
|
| Rate for Payer: UHC Exchange |
$185.89
|
| Rate for Payer: UHC Medicaid |
$131.09
|
| Rate for Payer: UHC Medicare Advantage |
$185.89
|
| Rate for Payer: UHCCP Medicaid |
$131.09
|
| Rate for Payer: VA VA |
$185.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.68
|
|
|
HC DIALYSIS CATH LVL 7 LONG TERM
|
Facility
|
IP
|
$743.57
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
27200319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$517.52 |
| Max. Negotiated Rate |
$669.21 |
| Rate for Payer: Aetna Commercial |
$632.03
|
| Rate for Payer: BCBS Trust/PPO |
$614.11
|
| Rate for Payer: BCN Commercial |
$614.11
|
| Rate for Payer: Cash Price |
$594.86
|
| Rate for Payer: Cofinity Commercial |
$639.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.86
|
| Rate for Payer: Healthscope Commercial |
$669.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.03
|
| Rate for Payer: Nomi Health Commercial |
$609.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.68
|
| Rate for Payer: PHP Commercial |
$632.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$646.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$517.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.34
|
| Rate for Payer: UHC Core |
$620.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.68
|
|
|
HC DIALYSIS CATH LVL 7 SHORT TERM
|
Facility
|
IP
|
$793.31
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$552.14 |
| Max. Negotiated Rate |
$713.98 |
| Rate for Payer: Aetna Commercial |
$674.31
|
| Rate for Payer: BCBS Trust/PPO |
$655.19
|
| Rate for Payer: BCN Commercial |
$655.19
|
| Rate for Payer: Cash Price |
$634.65
|
| Rate for Payer: Cofinity Commercial |
$682.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.65
|
| Rate for Payer: Healthscope Commercial |
$713.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.31
|
| Rate for Payer: Nomi Health Commercial |
$650.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.98
|
| Rate for Payer: PHP Commercial |
$674.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.11
|
| Rate for Payer: UHC Core |
$662.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.98
|
|
|
HC DIALYSIS CATH LVL 7 SHORT TERM
|
Facility
|
OP
|
$793.31
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.86 |
| Max. Negotiated Rate |
$713.98 |
| Rate for Payer: Aetna Commercial |
$674.31
|
| Rate for Payer: Aetna Medicare |
$206.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.91
|
| Rate for Payer: BCBS Complete |
$146.84
|
| Rate for Payer: BCBS MAPPO |
$198.33
|
| Rate for Payer: BCBS Trust/PPO |
$652.18
|
| Rate for Payer: BCN Commercial |
$652.18
|
| Rate for Payer: BCN Medicare Advantage |
$198.33
|
| Rate for Payer: Cash Price |
$634.65
|
| Rate for Payer: Cofinity Commercial |
$682.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.33
|
| Rate for Payer: Healthscope Commercial |
$713.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.98
|
| Rate for Payer: Mclaren Medicaid |
$139.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.24
|
| Rate for Payer: Meridian Medicaid |
$146.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.31
|
| Rate for Payer: Nomi Health Commercial |
$650.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.98
|
| Rate for Payer: PACE Senior Care Partners |
$188.41
|
| Rate for Payer: PACE SWMI |
$198.33
|
| Rate for Payer: PHP Commercial |
$674.31
|
| Rate for Payer: PHP Medicare Advantage |
$198.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.18
|
| Rate for Payer: Priority Health Medicare |
$200.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.14
|
| Rate for Payer: Railroad Medicare Medicare |
$198.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.11
|
| Rate for Payer: UHC Core |
$662.41
|
| Rate for Payer: UHC Exchange |
$198.33
|
| Rate for Payer: UHC Medicaid |
$139.86
|
| Rate for Payer: UHC Medicare Advantage |
$198.33
|
| Rate for Payer: UHCCP Medicaid |
$139.86
|
| Rate for Payer: VA VA |
$198.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.98
|
|
|
HC DIALYSIS CATH LVL 8 SHORT TERM
|
Facility
|
OP
|
$850.67
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$765.60 |
| Rate for Payer: Aetna Commercial |
$723.07
|
| Rate for Payer: Aetna Medicare |
$221.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$265.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$265.83
|
| Rate for Payer: BCBS Complete |
$157.46
|
| Rate for Payer: BCBS MAPPO |
$212.67
|
| Rate for Payer: BCBS Trust/PPO |
$699.34
|
| Rate for Payer: BCN Commercial |
$699.34
|
| Rate for Payer: BCN Medicare Advantage |
$212.67
|
| Rate for Payer: Cash Price |
$680.54
|
| Rate for Payer: Cofinity Commercial |
$731.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.67
|
| Rate for Payer: Healthscope Commercial |
$765.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.00
|
| Rate for Payer: Mclaren Medicaid |
$149.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.30
|
| Rate for Payer: Meridian Medicaid |
$157.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.07
|
| Rate for Payer: Nomi Health Commercial |
$697.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.00
|
| Rate for Payer: PACE Senior Care Partners |
$202.03
|
| Rate for Payer: PACE SWMI |
$212.67
|
| Rate for Payer: PHP Commercial |
$723.07
|
| Rate for Payer: PHP Medicare Advantage |
$212.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$740.08
|
| Rate for Payer: Priority Health Medicare |
$214.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$592.07
|
| Rate for Payer: Railroad Medicare Medicare |
$212.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.59
|
| Rate for Payer: UHC Core |
$710.31
|
| Rate for Payer: UHC Exchange |
$212.67
|
| Rate for Payer: UHC Medicaid |
$149.97
|
| Rate for Payer: UHC Medicare Advantage |
$212.67
|
| Rate for Payer: UHCCP Medicaid |
$149.97
|
| Rate for Payer: VA VA |
$212.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.00
|
|
|
HC DIALYSIS CATH LVL 8 SHORT TERM
|
Facility
|
IP
|
$850.67
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.07 |
| Max. Negotiated Rate |
$765.60 |
| Rate for Payer: Aetna Commercial |
$723.07
|
| Rate for Payer: BCBS Trust/PPO |
$702.57
|
| Rate for Payer: BCN Commercial |
$702.57
|
| Rate for Payer: Cash Price |
$680.54
|
| Rate for Payer: Cofinity Commercial |
$731.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.54
|
| Rate for Payer: Healthscope Commercial |
$765.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.07
|
| Rate for Payer: Nomi Health Commercial |
$697.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.00
|
| Rate for Payer: PHP Commercial |
$723.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$740.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$592.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.59
|
| Rate for Payer: UHC Core |
$710.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.00
|
|
|
HC DIALYSIS CATH LVL 9 LONG TERM
|
Facility
|
IP
|
$957.77
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.61 |
| Max. Negotiated Rate |
$861.99 |
| Rate for Payer: Aetna Commercial |
$814.10
|
| Rate for Payer: BCBS Trust/PPO |
$791.02
|
| Rate for Payer: BCN Commercial |
$791.02
|
| Rate for Payer: Cash Price |
$766.22
|
| Rate for Payer: Cofinity Commercial |
$823.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.22
|
| Rate for Payer: Healthscope Commercial |
$861.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.10
|
| Rate for Payer: Nomi Health Commercial |
$785.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.33
|
| Rate for Payer: PHP Commercial |
$814.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$833.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$666.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$842.84
|
| Rate for Payer: UHC Core |
$799.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.33
|
|
|
HC DIALYSIS CATH LVL 9 LONG TERM
|
Facility
|
OP
|
$957.77
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.85 |
| Max. Negotiated Rate |
$861.99 |
| Rate for Payer: Aetna Commercial |
$814.10
|
| Rate for Payer: Aetna Medicare |
$249.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$299.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$299.30
|
| Rate for Payer: BCBS Complete |
$177.28
|
| Rate for Payer: BCBS MAPPO |
$239.44
|
| Rate for Payer: BCBS Trust/PPO |
$787.38
|
| Rate for Payer: BCN Commercial |
$787.38
|
| Rate for Payer: BCN Medicare Advantage |
$239.44
|
| Rate for Payer: Cash Price |
$766.22
|
| Rate for Payer: Cofinity Commercial |
$823.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.44
|
| Rate for Payer: Healthscope Commercial |
$861.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.33
|
| Rate for Payer: Mclaren Medicaid |
$168.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.41
|
| Rate for Payer: Meridian Medicaid |
$177.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$263.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.10
|
| Rate for Payer: Nomi Health Commercial |
$785.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.33
|
| Rate for Payer: PACE Senior Care Partners |
$227.47
|
| Rate for Payer: PACE SWMI |
$239.44
|
| Rate for Payer: PHP Commercial |
$814.10
|
| Rate for Payer: PHP Medicare Advantage |
$239.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$833.26
|
| Rate for Payer: Priority Health Medicare |
$241.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$666.61
|
| Rate for Payer: Railroad Medicare Medicare |
$239.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$842.84
|
| Rate for Payer: UHC Core |
$799.74
|
| Rate for Payer: UHC Exchange |
$239.44
|
| Rate for Payer: UHC Medicaid |
$168.85
|
| Rate for Payer: UHC Medicare Advantage |
$239.44
|
| Rate for Payer: UHCCP Medicaid |
$168.85
|
| Rate for Payer: VA VA |
$239.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.33
|
|
|
HC DIFFUSION
|
Facility
|
OP
|
$404.49
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$71.31 |
| Max. Negotiated Rate |
$364.04 |
| Rate for Payer: Aetna Commercial |
$343.82
|
| Rate for Payer: Aetna Medicare |
$105.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.40
|
| Rate for Payer: BCBS Complete |
$74.87
|
| Rate for Payer: BCBS MAPPO |
$101.12
|
| Rate for Payer: BCBS Trust/PPO |
$332.53
|
| Rate for Payer: BCN Commercial |
$332.53
|
| Rate for Payer: BCN Medicare Advantage |
$101.12
|
| Rate for Payer: Cash Price |
$323.59
|
| Rate for Payer: Cofinity Commercial |
$347.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.12
|
| Rate for Payer: Healthscope Commercial |
$364.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.37
|
| Rate for Payer: Mclaren Medicaid |
$71.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.18
|
| Rate for Payer: Meridian Medicaid |
$74.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.82
|
| Rate for Payer: Nomi Health Commercial |
$331.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.37
|
| Rate for Payer: PACE Senior Care Partners |
$96.07
|
| Rate for Payer: PACE SWMI |
$101.12
|
| Rate for Payer: PHP Commercial |
$343.82
|
| Rate for Payer: PHP Medicare Advantage |
$101.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.91
|
| Rate for Payer: Priority Health Medicare |
$102.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.53
|
| Rate for Payer: Railroad Medicare Medicare |
$101.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.95
|
| Rate for Payer: UHC Core |
$337.75
|
| Rate for Payer: UHC Exchange |
$101.12
|
| Rate for Payer: UHC Medicaid |
$71.31
|
| Rate for Payer: UHC Medicare Advantage |
$101.12
|
| Rate for Payer: UHCCP Medicaid |
$71.31
|
| Rate for Payer: VA VA |
$101.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.37
|
|
