|
HC INFRARED THERAPY
|
Facility
|
OP
|
$57.48
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$51.73 |
| Rate for Payer: Aetna Commercial |
$48.86
|
| Rate for Payer: Aetna Medicare |
$14.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.96
|
| Rate for Payer: BCBS Complete |
$22.99
|
| Rate for Payer: BCBS MAPPO |
$14.37
|
| Rate for Payer: BCBS Trust/PPO |
$44.69
|
| Rate for Payer: BCN Commercial |
$44.69
|
| Rate for Payer: BCN Medicare Advantage |
$14.37
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cofinity Commercial |
$49.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.37
|
| Rate for Payer: Healthscope Commercial |
$51.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.86
|
| Rate for Payer: PACE Senior Care Partners |
$13.65
|
| Rate for Payer: PACE SWMI |
$14.37
|
| Rate for Payer: PHP Commercial |
$48.86
|
| Rate for Payer: PHP Medicare Advantage |
$14.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.01
|
| Rate for Payer: Priority Health Medicare |
$14.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.06
|
| Rate for Payer: Railroad Medicare Medicare |
$14.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.58
|
| Rate for Payer: UHC Core |
$48.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.37
|
| Rate for Payer: UHC Medicare Advantage |
$14.80
|
| Rate for Payer: VA VA |
$14.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.11
|
|
|
HC INFRARED THERAPY
|
Facility
|
IP
|
$57.48
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.06 |
| Max. Negotiated Rate |
$51.73 |
| Rate for Payer: Aetna Commercial |
$48.86
|
| Rate for Payer: BCBS Trust/PPO |
$44.42
|
| Rate for Payer: BCN Commercial |
$44.42
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cofinity Commercial |
$49.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.98
|
| Rate for Payer: Healthscope Commercial |
$51.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.86
|
| Rate for Payer: PHP Commercial |
$48.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.58
|
| Rate for Payer: UHC Core |
$48.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.11
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.41 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna Medicare |
$40.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.22
|
| Rate for Payer: BCBS Complete |
$63.00
|
| Rate for Payer: BCBS MAPPO |
$39.38
|
| Rate for Payer: BCBS Trust/PPO |
$122.46
|
| Rate for Payer: BCN Commercial |
$122.46
|
| Rate for Payer: BCN Medicare Advantage |
$39.38
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.38
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: PACE Senior Care Partners |
$37.41
|
| Rate for Payer: PACE SWMI |
$39.38
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: PHP Medicare Advantage |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.02
|
| Rate for Payer: Priority Health Medicare |
$39.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.06
|
| Rate for Payer: Railroad Medicare Medicare |
$39.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.60
|
| Rate for Payer: UHC Core |
$131.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.38
|
| Rate for Payer: UHC Medicare Advantage |
$40.56
|
| Rate for Payer: VA VA |
$39.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.06 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: BCBS Trust/PPO |
$121.72
|
| Rate for Payer: BCN Commercial |
$121.72
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.60
|
| Rate for Payer: UHC Core |
$131.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
IP
|
$237.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.62 |
| Max. Negotiated Rate |
$213.41 |
| Rate for Payer: Aetna Commercial |
$201.55
|
| Rate for Payer: BCBS Trust/PPO |
$183.25
|
| Rate for Payer: BCN Commercial |
$183.25
|
| Rate for Payer: Cash Price |
$189.70
|
| Rate for Payer: Cofinity Commercial |
$203.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.70
|
| Rate for Payer: Healthscope Commercial |
$213.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.55
|
| Rate for Payer: PHP Commercial |
$201.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.67
|
| Rate for Payer: UHC Core |
$198.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.84
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
OP
|
$237.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$213.41 |
| Rate for Payer: Aetna Commercial |
$201.55
|
| Rate for Payer: Aetna Medicare |
$61.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.10
|
| Rate for Payer: BCBS Complete |
$94.85
|
| Rate for Payer: BCBS MAPPO |
$59.28
|
| Rate for Payer: BCBS Trust/PPO |
$184.36
|
| Rate for Payer: BCN Commercial |
$184.36
|
| Rate for Payer: BCN Medicare Advantage |
$59.28
|
| Rate for Payer: Cash Price |
$189.70
|
| Rate for Payer: Cofinity Commercial |
$203.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.28
|
| Rate for Payer: Healthscope Commercial |
$213.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.55
|
| Rate for Payer: PACE Senior Care Partners |
$56.32
|
| Rate for Payer: PACE SWMI |
$59.28
|
| Rate for Payer: PHP Commercial |
$201.55
|
| Rate for Payer: PHP Medicare Advantage |
$59.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.29
|
| Rate for Payer: Priority Health Medicare |
$59.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.62
|
| Rate for Payer: Railroad Medicare Medicare |
$59.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.67
|
| Rate for Payer: UHC Core |
$198.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.28
|
| Rate for Payer: UHC Medicare Advantage |
$61.06
|
| Rate for Payer: VA VA |
$59.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.84
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
IP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.07 |
| Max. Negotiated Rate |
$357.21 |
| Rate for Payer: Aetna Commercial |
$337.36
|
| Rate for Payer: BCBS Trust/PPO |
$306.72
|
| Rate for Payer: BCN Commercial |
$306.72
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Commercial |
$341.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Healthscope Commercial |
$357.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.36
|
| Rate for Payer: PHP Commercial |
$337.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.27
|
| Rate for Payer: UHC Core |
$331.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.68
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
OP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.26 |
| Max. Negotiated Rate |
$357.21 |
| Rate for Payer: Aetna Commercial |
$337.36
|
| Rate for Payer: Aetna Medicare |
$103.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.03
|
| Rate for Payer: BCBS Complete |
$158.76
|
| Rate for Payer: BCBS MAPPO |
$99.22
|
| Rate for Payer: BCBS Trust/PPO |
$308.59
|
| Rate for Payer: BCN Commercial |
$308.59
|
| Rate for Payer: BCN Medicare Advantage |
$99.22
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Commercial |
$341.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.22
|
| Rate for Payer: Healthscope Commercial |
$357.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$104.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.36
|
| Rate for Payer: PACE Senior Care Partners |
$94.26
|
| Rate for Payer: PACE SWMI |
$99.22
|
| Rate for Payer: PHP Commercial |
$337.36
|
| Rate for Payer: PHP Medicare Advantage |
$99.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.30
|
| Rate for Payer: Priority Health Medicare |
$99.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.07
|
| Rate for Payer: Railroad Medicare Medicare |
$99.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.27
|
| Rate for Payer: UHC Core |
$331.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.22
|
| Rate for Payer: UHC Medicare Advantage |
$102.20
|
| Rate for Payer: VA VA |
$99.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.68
|
|
|
HC INFUSION CATHETER LVL 6
|
Facility
|
OP
|
$662.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.43 |
| Max. Negotiated Rate |
$596.57 |
| Rate for Payer: Aetna Commercial |
$563.43
|
| Rate for Payer: Aetna Medicare |
$172.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.14
|
| Rate for Payer: BCBS Complete |
$265.14
|
| Rate for Payer: BCBS MAPPO |
$165.72
|
| Rate for Payer: BCBS Trust/PPO |
$515.37
|
| Rate for Payer: BCN Commercial |
$515.37
|
| Rate for Payer: BCN Medicare Advantage |
$165.72
|
| Rate for Payer: Cash Price |
$530.29
|
| Rate for Payer: Cofinity Commercial |
$570.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.72
|
| Rate for Payer: Healthscope Commercial |
$596.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$174.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.43
|
| Rate for Payer: PACE Senior Care Partners |
$157.43
|
| Rate for Payer: PACE SWMI |
$165.72
|
| Rate for Payer: PHP Commercial |
$563.43
|
| Rate for Payer: PHP Medicare Advantage |
$165.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$576.69
|
| Rate for Payer: Priority Health Medicare |
$165.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$404.28
|
| Rate for Payer: Railroad Medicare Medicare |
$165.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$583.32
|
| Rate for Payer: UHC Core |
$553.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.72
|
| Rate for Payer: UHC Medicare Advantage |
$170.69
|
| Rate for Payer: VA VA |
$165.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.14
|
|
|
HC INFUSION CATHETER LVL 6
|
Facility
|
IP
|
$662.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$404.28 |
| Max. Negotiated Rate |
$596.57 |
| Rate for Payer: Aetna Commercial |
$563.43
|
| Rate for Payer: BCBS Trust/PPO |
$512.26
|
| Rate for Payer: BCN Commercial |
$512.26
|
| Rate for Payer: Cash Price |
$530.29
|
| Rate for Payer: Cofinity Commercial |
$570.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.29
|
| Rate for Payer: Healthscope Commercial |
$596.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.43
|
| Rate for Payer: PHP Commercial |
$563.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$576.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$404.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$583.32
|
| Rate for Payer: UHC Core |
$553.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.14
|
|
|
HC INFUSION CATHETER LVL 7
|
Facility
|
OP
|
$740.38
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.84 |
| Max. Negotiated Rate |
$666.34 |
| Rate for Payer: Aetna Commercial |
$629.32
|
| Rate for Payer: Aetna Medicare |
$192.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.37
|
| Rate for Payer: BCBS Complete |
$296.15
|
| Rate for Payer: BCBS MAPPO |
$185.10
|
| Rate for Payer: BCBS Trust/PPO |
$575.65
|
| Rate for Payer: BCN Commercial |
$575.65
|
| Rate for Payer: BCN Medicare Advantage |
$185.10
|
| Rate for Payer: Cash Price |
$592.30
|
| Rate for Payer: Cofinity Commercial |
$636.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.10
|
| Rate for Payer: Healthscope Commercial |
$666.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$194.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.32
|
| Rate for Payer: PACE Senior Care Partners |
$175.84
|
| Rate for Payer: PACE SWMI |
$185.10
|
| Rate for Payer: PHP Commercial |
$629.32
|
| Rate for Payer: PHP Medicare Advantage |
$185.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.13
|
| Rate for Payer: Priority Health Medicare |
$185.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.56
|
| Rate for Payer: Railroad Medicare Medicare |
$185.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$651.53
|
| Rate for Payer: UHC Core |
$618.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.10
|
| Rate for Payer: UHC Medicare Advantage |
$190.65
|
| Rate for Payer: VA VA |
$185.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.28
|
|
|
HC INFUSION CATHETER LVL 7
|
Facility
|
IP
|
$740.38
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.56 |
| Max. Negotiated Rate |
$666.34 |
| Rate for Payer: Aetna Commercial |
$629.32
|
| Rate for Payer: BCBS Trust/PPO |
$572.17
|
| Rate for Payer: BCN Commercial |
$572.17
|
| Rate for Payer: Cash Price |
$592.30
|
| Rate for Payer: Cofinity Commercial |
$636.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.30
|
| Rate for Payer: Healthscope Commercial |
$666.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.32
|
| Rate for Payer: PHP Commercial |
$629.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$651.53
|
| Rate for Payer: UHC Core |
$618.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.28
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
IP
|
$904.18
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$551.46 |
| Max. Negotiated Rate |
$813.76 |
| Rate for Payer: Aetna Commercial |
$768.55
|
| Rate for Payer: BCBS Trust/PPO |
$698.75
|
| Rate for Payer: BCN Commercial |
$698.75
|
| Rate for Payer: Cash Price |
$723.34
|
| Rate for Payer: Cofinity Commercial |
$777.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.34
|
| Rate for Payer: Healthscope Commercial |
$813.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$678.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.55
|
| Rate for Payer: PHP Commercial |
$768.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$786.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$551.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.68
|
| Rate for Payer: UHC Core |
$754.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$678.14
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
OP
|
$904.18
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.74 |
| Max. Negotiated Rate |
$813.76 |
| Rate for Payer: Aetna Commercial |
$768.55
|
| Rate for Payer: Aetna Medicare |
$235.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$282.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$282.56
|
| Rate for Payer: BCBS Complete |
$361.67
|
| Rate for Payer: BCBS MAPPO |
$226.04
|
| Rate for Payer: BCBS Trust/PPO |
$703.00
|
| Rate for Payer: BCN Commercial |
$703.00
|
| Rate for Payer: BCN Medicare Advantage |
$226.04
|
| Rate for Payer: Cash Price |
$723.34
|
| Rate for Payer: Cofinity Commercial |
$777.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.04
|
| Rate for Payer: Healthscope Commercial |
$813.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$678.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.55
|
| Rate for Payer: PACE Senior Care Partners |
$214.74
|
| Rate for Payer: PACE SWMI |
$226.04
|
| Rate for Payer: PHP Commercial |
$768.55
|
| Rate for Payer: PHP Medicare Advantage |
$226.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$786.64
|
| Rate for Payer: Priority Health Medicare |
$226.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$551.46
|
| Rate for Payer: Railroad Medicare Medicare |
$226.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.68
|
| Rate for Payer: UHC Core |
$754.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.04
|
| Rate for Payer: UHC Medicare Advantage |
$232.83
|
| Rate for Payer: VA VA |
$226.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$678.14
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
OP
|
$1,006.71
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.09 |
| Max. Negotiated Rate |
$906.04 |
| Rate for Payer: Aetna Commercial |
$855.70
|
| Rate for Payer: Aetna Medicare |
$261.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$314.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$314.60
|
| Rate for Payer: BCBS Complete |
$402.68
|
| Rate for Payer: BCBS MAPPO |
$251.68
|
| Rate for Payer: BCBS Trust/PPO |
$782.72
|
| Rate for Payer: BCN Commercial |
$782.72
|
| Rate for Payer: BCN Medicare Advantage |
$251.68
|
| Rate for Payer: Cash Price |
$805.37
|
| Rate for Payer: Cofinity Commercial |
$865.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$805.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.68
|
| Rate for Payer: Healthscope Commercial |
$906.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$755.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$264.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$855.70
|
| Rate for Payer: PACE Senior Care Partners |
$239.09
|
| Rate for Payer: PACE SWMI |
$251.68
|
| Rate for Payer: PHP Commercial |
$855.70
|
| Rate for Payer: PHP Medicare Advantage |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.84
|
| Rate for Payer: Priority Health Medicare |
$251.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$613.99
|
| Rate for Payer: Railroad Medicare Medicare |
$251.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.90
|
| Rate for Payer: UHC Core |
$840.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.68
|
| Rate for Payer: UHC Medicare Advantage |
$259.23
|
| Rate for Payer: VA VA |
$251.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$755.03
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
IP
|
$1,006.71
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$613.99 |
| Max. Negotiated Rate |
$906.04 |
| Rate for Payer: Aetna Commercial |
$855.70
|
| Rate for Payer: BCBS Trust/PPO |
$777.99
|
| Rate for Payer: BCN Commercial |
$777.99
|
| Rate for Payer: Cash Price |
$805.37
|
| Rate for Payer: Cofinity Commercial |
$865.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$805.37
|
| Rate for Payer: Healthscope Commercial |
$906.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$755.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$855.70
|
| Rate for Payer: PHP Commercial |
$855.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$613.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.90
|
| Rate for Payer: UHC Core |
$840.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$755.03
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
OP
|
$1,120.87
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.21 |
| Max. Negotiated Rate |
$1,008.78 |
| Rate for Payer: Aetna Commercial |
$952.74
|
| Rate for Payer: Aetna Medicare |
$291.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$350.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$350.27
|
| Rate for Payer: BCBS Complete |
$448.35
|
| Rate for Payer: BCBS MAPPO |
$280.22
|
| Rate for Payer: BCBS Trust/PPO |
$871.48
|
| Rate for Payer: BCN Commercial |
$871.48
|
| Rate for Payer: BCN Medicare Advantage |
$280.22
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cofinity Commercial |
$963.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.22
|
| Rate for Payer: Healthscope Commercial |
$1,008.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$840.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$294.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$952.74
|
| Rate for Payer: PACE Senior Care Partners |
$266.21
|
| Rate for Payer: PACE SWMI |
$280.22
|
| Rate for Payer: PHP Commercial |
$952.74
|
| Rate for Payer: PHP Medicare Advantage |
$280.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$975.16
|
| Rate for Payer: Priority Health Medicare |
$280.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.62
|
| Rate for Payer: Railroad Medicare Medicare |
$280.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$986.37
|
| Rate for Payer: UHC Core |
$935.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.22
|
| Rate for Payer: UHC Medicare Advantage |
$288.62
|
| Rate for Payer: VA VA |
$280.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$840.65
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
IP
|
$1,120.87
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.62 |
| Max. Negotiated Rate |
$1,008.78 |
| Rate for Payer: Aetna Commercial |
$952.74
|
| Rate for Payer: BCBS Trust/PPO |
$866.21
|
| Rate for Payer: BCN Commercial |
$866.21
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cofinity Commercial |
$963.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.70
|
| Rate for Payer: Healthscope Commercial |
$1,008.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$840.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$952.74
|
| Rate for Payer: PHP Commercial |
$952.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$975.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$986.37
|
| Rate for Payer: UHC Core |
$935.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$840.65
|
|
|
HC INFUSION CATH LVL 12
|
Facility
|
IP
|
$1,247.97
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.14 |
| Max. Negotiated Rate |
$1,123.17 |
| Rate for Payer: Aetna Commercial |
$1,060.77
|
| Rate for Payer: BCBS Trust/PPO |
$964.43
|
| Rate for Payer: BCN Commercial |
$964.43
|
| Rate for Payer: Cash Price |
$998.38
|
| Rate for Payer: Cofinity Commercial |
$1,073.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$998.38
|
| Rate for Payer: Healthscope Commercial |
$1,123.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$935.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,060.77
|
| Rate for Payer: PHP Commercial |
$1,060.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$873.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,085.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$761.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,098.21
|
| Rate for Payer: UHC Core |
$1,042.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$935.98
|
|
|
HC INFUSION CATH LVL 12
|
Facility
|
OP
|
$1,247.97
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$296.39 |
| Max. Negotiated Rate |
$1,123.17 |
| Rate for Payer: Aetna Commercial |
$1,060.77
|
| Rate for Payer: Aetna Medicare |
$324.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$389.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$389.99
|
| Rate for Payer: BCBS Complete |
$499.19
|
| Rate for Payer: BCBS MAPPO |
$311.99
|
| Rate for Payer: BCBS Trust/PPO |
$970.30
|
| Rate for Payer: BCN Commercial |
$970.30
|
| Rate for Payer: BCN Medicare Advantage |
$311.99
|
| Rate for Payer: Cash Price |
$998.38
|
| Rate for Payer: Cofinity Commercial |
$1,073.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$998.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.99
|
| Rate for Payer: Healthscope Commercial |
$1,123.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$935.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$327.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$358.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,060.77
|
| Rate for Payer: PACE Senior Care Partners |
$296.39
|
| Rate for Payer: PACE SWMI |
$311.99
|
| Rate for Payer: PHP Commercial |
$1,060.77
|
| Rate for Payer: PHP Medicare Advantage |
$311.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$873.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,085.73
|
| Rate for Payer: Priority Health Medicare |
$311.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$761.14
|
| Rate for Payer: Railroad Medicare Medicare |
$311.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,098.21
|
| Rate for Payer: UHC Core |
$1,042.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.99
|
| Rate for Payer: UHC Medicare Advantage |
$321.35
|
| Rate for Payer: VA VA |
$311.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$935.98
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.19 |
| Max. Negotiated Rate |
$1,217.70 |
| Rate for Payer: Aetna Commercial |
$1,150.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,045.60
|
| Rate for Payer: BCN Commercial |
$1,045.60
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$1,163.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.40
|
| Rate for Payer: Healthscope Commercial |
$1,217.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,014.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.05
|
| Rate for Payer: PHP Commercial |
$1,150.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,177.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$825.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.64
|
| Rate for Payer: UHC Core |
$1,129.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,014.75
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.34 |
| Max. Negotiated Rate |
$1,217.70 |
| Rate for Payer: Aetna Commercial |
$1,150.05
|
| Rate for Payer: Aetna Medicare |
$351.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.81
|
| Rate for Payer: BCBS Complete |
$541.20
|
| Rate for Payer: BCBS MAPPO |
$338.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,051.96
|
| Rate for Payer: BCN Commercial |
$1,051.96
|
| Rate for Payer: BCN Medicare Advantage |
$338.25
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$1,163.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.25
|
| Rate for Payer: Healthscope Commercial |
$1,217.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,014.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$355.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.05
|
| Rate for Payer: PACE Senior Care Partners |
$321.34
|
| Rate for Payer: PACE SWMI |
$338.25
|
| Rate for Payer: PHP Commercial |
$1,150.05
|
| Rate for Payer: PHP Medicare Advantage |
$338.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,177.11
|
| Rate for Payer: Priority Health Medicare |
$338.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$825.19
|
| Rate for Payer: Railroad Medicare Medicare |
$338.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.64
|
| Rate for Payer: UHC Core |
$1,129.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.25
|
| Rate for Payer: UHC Medicare Advantage |
$348.40
|
| Rate for Payer: VA VA |
$338.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,014.75
|
|
|
HC INFUSION CATH LVL 14
|
Facility
|
IP
|
$1,446.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$882.46 |
| Max. Negotiated Rate |
$1,302.21 |
| Rate for Payer: Aetna Commercial |
$1,229.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.16
|
| Rate for Payer: BCN Commercial |
$1,118.16
|
| Rate for Payer: Cash Price |
$1,157.52
|
| Rate for Payer: Cofinity Commercial |
$1,244.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.52
|
| Rate for Payer: Healthscope Commercial |
$1,302.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,229.86
|
| Rate for Payer: PHP Commercial |
$1,229.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,258.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$882.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,273.27
|
| Rate for Payer: UHC Core |
$1,208.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.18
|
|
|
HC INFUSION CATH LVL 14
|
Facility
|
OP
|
$1,446.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.64 |
| Max. Negotiated Rate |
$1,302.21 |
| Rate for Payer: Aetna Commercial |
$1,229.86
|
| Rate for Payer: Aetna Medicare |
$376.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$452.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$452.16
|
| Rate for Payer: BCBS Complete |
$578.76
|
| Rate for Payer: BCBS MAPPO |
$361.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.96
|
| Rate for Payer: BCN Commercial |
$1,124.96
|
| Rate for Payer: BCN Medicare Advantage |
$361.72
|
| Rate for Payer: Cash Price |
$1,157.52
|
| Rate for Payer: Cofinity Commercial |
$1,244.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.72
|
| Rate for Payer: Healthscope Commercial |
$1,302.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$379.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$415.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,229.86
|
| Rate for Payer: PACE Senior Care Partners |
$343.64
|
| Rate for Payer: PACE SWMI |
$361.72
|
| Rate for Payer: PHP Commercial |
$1,229.86
|
| Rate for Payer: PHP Medicare Advantage |
$361.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,258.80
|
| Rate for Payer: Priority Health Medicare |
$361.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$882.46
|
| Rate for Payer: Railroad Medicare Medicare |
$361.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,273.27
|
| Rate for Payer: UHC Core |
$1,208.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$361.72
|
| Rate for Payer: UHC Medicare Advantage |
$372.58
|
| Rate for Payer: VA VA |
$361.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.18
|
|
|
HC INFUSION CATH LVL 4
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.62
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS MAPPO |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$349.88
|
| Rate for Payer: BCN Commercial |
$349.88
|
| Rate for Payer: BCN Medicare Advantage |
$112.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.50
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$118.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PACE Senior Care Partners |
$106.88
|
| Rate for Payer: PACE SWMI |
$112.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$112.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.50
|
| Rate for Payer: Priority Health Medicare |
$112.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: Railroad Medicare Medicare |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.50
|
| Rate for Payer: UHC Medicare Advantage |
$115.88
|
| Rate for Payer: VA VA |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
