|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
IP
|
$63.09
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.01 |
| Max. Negotiated Rate |
$56.78 |
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: BCBS Trust/PPO |
$51.50
|
| Rate for Payer: BCN Commercial |
$48.76
|
| Rate for Payer: Cash Price |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.47
|
| Rate for Payer: Healthscope Commercial |
$56.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.63
|
| Rate for Payer: Nomi Health Commercial |
$51.73
|
| Rate for Payer: PHP Commercial |
$53.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.01
|
| Rate for Payer: Priority Health HMO/PPO |
$54.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.52
|
| Rate for Payer: UHC Core |
$52.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.32
|
|
|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
OP
|
$63.09
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$56.78 |
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Aetna Medicare |
$16.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.72
|
| Rate for Payer: BCBS Complete |
$25.24
|
| Rate for Payer: BCBS MAPPO |
$15.77
|
| Rate for Payer: BCBS Trust/PPO |
$51.87
|
| Rate for Payer: BCN Commercial |
$49.05
|
| Rate for Payer: BCN Medicare Advantage |
$15.77
|
| Rate for Payer: Cash Price |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.77
|
| Rate for Payer: Healthscope Commercial |
$56.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.63
|
| Rate for Payer: Nomi Health Commercial |
$51.73
|
| Rate for Payer: PACE Senior Care Partners |
$14.98
|
| Rate for Payer: PACE SWMI |
$15.77
|
| Rate for Payer: PHP Commercial |
$53.63
|
| Rate for Payer: PHP Medicare Advantage |
$15.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.01
|
| Rate for Payer: Priority Health HMO/PPO |
$54.89
|
| Rate for Payer: Priority Health Medicare |
$15.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.27
|
| Rate for Payer: Railroad Medicare Medicare |
$15.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.52
|
| Rate for Payer: UHC Core |
$52.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.77
|
| Rate for Payer: UHC Exchange |
$15.77
|
| Rate for Payer: UHC Medicare Advantage |
$15.77
|
| Rate for Payer: VA VA |
$15.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.32
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
OP
|
$48.68
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$43.81 |
| Rate for Payer: Aetna Commercial |
$41.38
|
| Rate for Payer: Aetna Medicare |
$12.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.21
|
| Rate for Payer: BCBS Complete |
$16.25
|
| Rate for Payer: BCBS MAPPO |
$12.17
|
| Rate for Payer: BCBS Trust/PPO |
$40.02
|
| Rate for Payer: BCN Commercial |
$37.85
|
| Rate for Payer: BCN Medicare Advantage |
$12.17
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cofinity Commercial |
$41.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$43.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.51
|
| Rate for Payer: Mclaren Medicaid |
$15.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.78
|
| Rate for Payer: Meridian Medicaid |
$16.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.38
|
| Rate for Payer: Nomi Health Commercial |
$39.92
|
| Rate for Payer: PACE Senior Care Partners |
$11.56
|
| Rate for Payer: PACE SWMI |
$12.17
|
| Rate for Payer: PHP Commercial |
$41.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.64
|
| Rate for Payer: Priority Health HMO/PPO |
$42.35
|
| Rate for Payer: Priority Health Medicare |
$12.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.62
|
| Rate for Payer: Railroad Medicare Medicare |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.84
|
| Rate for Payer: UHC Core |
$40.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.17
|
| Rate for Payer: UHC Exchange |
$12.17
|
| Rate for Payer: UHC Medicare Advantage |
$12.17
|
| Rate for Payer: UHCCP Medicaid |
$15.48
|
| Rate for Payer: VA VA |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.51
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
IP
|
$48.68
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$43.81 |
| Rate for Payer: Aetna Commercial |
$41.38
|
| Rate for Payer: BCBS Trust/PPO |
$39.74
|
| Rate for Payer: BCN Commercial |
$37.62
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cofinity Commercial |
$41.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.94
|
| Rate for Payer: Healthscope Commercial |
$43.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.38
|
| Rate for Payer: Nomi Health Commercial |
$39.92
|
| Rate for Payer: PHP Commercial |
$41.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.64
|
| Rate for Payer: Priority Health HMO/PPO |
$42.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.84
|
| Rate for Payer: UHC Core |
$40.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.51
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
OP
|
$149.77
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$134.79 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Medicare |
$38.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.80
|
| Rate for Payer: BCBS Complete |
$59.91
|
| Rate for Payer: BCBS MAPPO |
$37.44
|
| Rate for Payer: BCBS Trust/PPO |
$123.13
|
| Rate for Payer: BCN Commercial |
$116.45
|
| Rate for Payer: BCN Medicare Advantage |
$37.44
|
| Rate for Payer: Cash Price |
$119.82
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.44
|
| Rate for Payer: Healthscope Commercial |
$134.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.30
|
| Rate for Payer: Nomi Health Commercial |
$122.81
|
| Rate for Payer: PACE Senior Care Partners |
$35.57
|
| Rate for Payer: PACE SWMI |
$37.44
|
| Rate for Payer: PHP Commercial |
$127.30
|
| Rate for Payer: PHP Medicare Advantage |
$37.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.35
|
| Rate for Payer: Priority Health HMO/PPO |
$130.30
|
| Rate for Payer: Priority Health Medicare |
$37.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.35
|
| Rate for Payer: Railroad Medicare Medicare |
$37.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.80
|
| Rate for Payer: UHC Core |
$125.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.44
|
| Rate for Payer: UHC Exchange |
$37.44
|
| Rate for Payer: UHC Medicare Advantage |
$37.44
|
| Rate for Payer: VA VA |
$37.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.33
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
IP
|
$149.77
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$134.79 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: BCBS Trust/PPO |
$122.26
|
| Rate for Payer: BCN Commercial |
$115.74
|
| Rate for Payer: Cash Price |
$119.82
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.82
|
| Rate for Payer: Healthscope Commercial |
$134.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.30
|
| Rate for Payer: Nomi Health Commercial |
$122.81
|
| Rate for Payer: PHP Commercial |
$127.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.35
|
| Rate for Payer: Priority Health HMO/PPO |
$130.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.80
|
| Rate for Payer: UHC Core |
$125.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.33
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
OP
|
$11,009.31
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,614.71 |
| Max. Negotiated Rate |
$9,908.38 |
| Rate for Payer: Aetna Commercial |
$9,357.91
|
| Rate for Payer: Aetna Medicare |
$2,862.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,440.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,440.41
|
| Rate for Payer: BCBS Complete |
$4,328.59
|
| Rate for Payer: BCBS MAPPO |
$2,752.33
|
| Rate for Payer: BCBS Trust/PPO |
$9,050.75
|
| Rate for Payer: BCN Commercial |
$8,559.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,752.33
|
| Rate for Payer: Cash Price |
$8,807.45
|
| Rate for Payer: Cash Price |
$8,807.45
|
| Rate for Payer: Cofinity Commercial |
$9,468.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,807.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,752.33
|
| Rate for Payer: Healthscope Commercial |
$9,908.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,256.98
|
| Rate for Payer: Mclaren Medicaid |
$4,122.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,889.94
|
| Rate for Payer: Meridian Medicaid |
$4,328.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,165.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,357.91
|
| Rate for Payer: Nomi Health Commercial |
$9,027.63
|
| Rate for Payer: PACE Senior Care Partners |
$2,614.71
|
| Rate for Payer: PACE SWMI |
$2,752.33
|
| Rate for Payer: PHP Commercial |
$9,357.91
|
| Rate for Payer: PHP Medicare Advantage |
$2,752.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,122.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,156.05
|
| Rate for Payer: Priority Health HMO/PPO |
$9,578.10
|
| Rate for Payer: Priority Health Medicare |
$2,779.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,376.24
|
| Rate for Payer: Railroad Medicare Medicare |
$2,752.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.19
|
| Rate for Payer: UHC Core |
$9,192.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,752.33
|
| Rate for Payer: UHC Exchange |
$2,752.33
|
| Rate for Payer: UHC Medicare Advantage |
$2,752.33
|
| Rate for Payer: UHCCP Medicaid |
$4,122.20
|
| Rate for Payer: VA VA |
$2,752.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,256.98
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
IP
|
$11,009.31
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,156.05 |
| Max. Negotiated Rate |
$9,908.38 |
| Rate for Payer: Aetna Commercial |
$9,357.91
|
| Rate for Payer: BCBS Trust/PPO |
$8,986.90
|
| Rate for Payer: BCN Commercial |
$8,507.99
|
| Rate for Payer: Cash Price |
$8,807.45
|
| Rate for Payer: Cofinity Commercial |
$9,468.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,807.45
|
| Rate for Payer: Healthscope Commercial |
$9,908.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,256.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,357.91
|
| Rate for Payer: Nomi Health Commercial |
$9,027.63
|
| Rate for Payer: PHP Commercial |
$9,357.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,156.05
|
| Rate for Payer: Priority Health HMO/PPO |
$9,578.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,376.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.19
|
| Rate for Payer: UHC Core |
$9,192.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,256.98
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$2,146.12
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
36100525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,394.98 |
| Max. Negotiated Rate |
$1,931.51 |
| Rate for Payer: Aetna Commercial |
$1,824.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,751.88
|
| Rate for Payer: BCN Commercial |
$1,658.52
|
| Rate for Payer: Cash Price |
$1,716.90
|
| Rate for Payer: Cofinity Commercial |
$1,845.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,716.90
|
| Rate for Payer: Healthscope Commercial |
$1,931.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,609.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.20
|
| Rate for Payer: Nomi Health Commercial |
$1,759.82
|
| Rate for Payer: PHP Commercial |
$1,824.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.98
|
| Rate for Payer: Priority Health HMO/PPO |
$1,867.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,437.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,888.59
|
| Rate for Payer: UHC Core |
$1,792.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,609.59
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$2,146.12
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
36100525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,931.51 |
| Rate for Payer: Aetna Commercial |
$1,824.20
|
| Rate for Payer: Aetna Medicare |
$557.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$670.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$670.66
|
| Rate for Payer: BCBS Complete |
$1,179.37
|
| Rate for Payer: BCBS MAPPO |
$536.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,764.33
|
| Rate for Payer: BCN Commercial |
$1,668.61
|
| Rate for Payer: BCN Medicare Advantage |
$536.53
|
| Rate for Payer: Cash Price |
$1,716.90
|
| Rate for Payer: Cash Price |
$1,716.90
|
| Rate for Payer: Cofinity Commercial |
$1,845.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,716.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$536.53
|
| Rate for Payer: Healthscope Commercial |
$1,931.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,609.59
|
| Rate for Payer: Mclaren Medicaid |
$1,123.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$563.36
|
| Rate for Payer: Meridian Medicaid |
$1,179.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.20
|
| Rate for Payer: Nomi Health Commercial |
$1,759.82
|
| Rate for Payer: PACE Senior Care Partners |
$509.70
|
| Rate for Payer: PACE SWMI |
$536.53
|
| Rate for Payer: PHP Commercial |
$1,824.20
|
| Rate for Payer: PHP Medicare Advantage |
$536.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,123.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.98
|
| Rate for Payer: Priority Health HMO/PPO |
$1,867.12
|
| Rate for Payer: Priority Health Medicare |
$541.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,437.90
|
| Rate for Payer: Railroad Medicare Medicare |
$536.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,888.59
|
| Rate for Payer: UHC Core |
$1,792.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$536.53
|
| Rate for Payer: UHC Exchange |
$536.53
|
| Rate for Payer: UHC Medicare Advantage |
$536.53
|
| Rate for Payer: UHCCP Medicaid |
$1,123.14
|
| Rate for Payer: VA VA |
$536.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,609.59
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING
|
Facility
|
OP
|
$18,535.04
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
36100527
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,402.07 |
| Max. Negotiated Rate |
$16,681.54 |
| Rate for Payer: Aetna Commercial |
$15,754.78
|
| Rate for Payer: Aetna Medicare |
$4,819.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,792.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,792.20
|
| Rate for Payer: BCBS Complete |
$8,609.76
|
| Rate for Payer: BCBS MAPPO |
$4,633.76
|
| Rate for Payer: BCBS Trust/PPO |
$15,237.66
|
| Rate for Payer: BCN Commercial |
$14,410.99
|
| Rate for Payer: BCN Medicare Advantage |
$4,633.76
|
| Rate for Payer: Cash Price |
$14,828.03
|
| Rate for Payer: Cash Price |
$14,828.03
|
| Rate for Payer: Cofinity Commercial |
$15,940.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,828.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,633.76
|
| Rate for Payer: Healthscope Commercial |
$16,681.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,901.28
|
| Rate for Payer: Mclaren Medicaid |
$8,199.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,865.45
|
| Rate for Payer: Meridian Medicaid |
$8,609.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,328.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,754.78
|
| Rate for Payer: Nomi Health Commercial |
$15,198.73
|
| Rate for Payer: PACE Senior Care Partners |
$4,402.07
|
| Rate for Payer: PACE SWMI |
$4,633.76
|
| Rate for Payer: PHP Commercial |
$15,754.78
|
| Rate for Payer: PHP Medicare Advantage |
$4,633.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,199.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,047.78
|
| Rate for Payer: Priority Health HMO/PPO |
$16,125.48
|
| Rate for Payer: Priority Health Medicare |
$4,680.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,418.48
|
| Rate for Payer: Railroad Medicare Medicare |
$4,633.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,310.84
|
| Rate for Payer: UHC Core |
$15,476.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,633.76
|
| Rate for Payer: UHC Exchange |
$4,633.76
|
| Rate for Payer: UHC Medicare Advantage |
$4,633.76
|
| Rate for Payer: UHCCP Medicaid |
$8,199.23
|
| Rate for Payer: VA VA |
$4,633.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,901.28
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING
|
Facility
|
IP
|
$18,535.04
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
36100527
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,047.78 |
| Max. Negotiated Rate |
$16,681.54 |
| Rate for Payer: Aetna Commercial |
$15,754.78
|
| Rate for Payer: BCBS Trust/PPO |
$15,130.15
|
| Rate for Payer: BCN Commercial |
$14,323.88
|
| Rate for Payer: Cash Price |
$14,828.03
|
| Rate for Payer: Cofinity Commercial |
$15,940.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,828.03
|
| Rate for Payer: Healthscope Commercial |
$16,681.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,901.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,754.78
|
| Rate for Payer: Nomi Health Commercial |
$15,198.73
|
| Rate for Payer: PHP Commercial |
$15,754.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,047.78
|
| Rate for Payer: Priority Health HMO/PPO |
$16,125.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,418.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,310.84
|
| Rate for Payer: UHC Core |
$15,476.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,901.28
|
|
|
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 |
$248.77 |
| 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 |
$418.98
|
| Rate for Payer: BCBS MAPPO |
$261.86
|
| Rate for Payer: BCBS Trust/PPO |
$861.10
|
| Rate for Payer: BCN Commercial |
$814.38
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$274.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$301.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.32
|
| Rate for Payer: Nomi Health Commercial |
$858.90
|
| 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 Cigna Priority Health |
$680.84
|
| Rate for Payer: Priority Health HMO/PPO |
$911.27
|
| Rate for Payer: Priority Health Medicare |
$264.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$701.78
|
| 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 Dual Complete DSNP |
$261.86
|
| Rate for Payer: UHC Exchange |
$261.86
|
| Rate for Payer: UHC Medicare Advantage |
$261.86
|
| 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 |
$680.84 |
| Max. Negotiated Rate |
$942.70 |
| Rate for Payer: Aetna Commercial |
$890.32
|
| Rate for Payer: BCBS Trust/PPO |
$855.03
|
| Rate for Payer: BCN Commercial |
$809.46
|
| 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: PHP Commercial |
$890.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.84
|
| Rate for Payer: Priority Health HMO/PPO |
$911.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$701.78
|
| 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
|
IP
|
$1,171.97
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.78 |
| Max. Negotiated Rate |
$1,054.77 |
| Rate for Payer: Aetna Commercial |
$996.17
|
| Rate for Payer: BCBS Trust/PPO |
$956.68
|
| Rate for Payer: BCN Commercial |
$905.70
|
| 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: PHP Commercial |
$996.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.78
|
| Rate for Payer: Priority Health HMO/PPO |
$1,019.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$785.22
|
| 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 11 LONG TERM
|
Facility
|
OP
|
$1,171.97
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.34 |
| 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 |
$468.79
|
| Rate for Payer: BCBS MAPPO |
$292.99
|
| Rate for Payer: BCBS Trust/PPO |
$963.48
|
| Rate for Payer: BCN Commercial |
$911.21
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.17
|
| Rate for Payer: Nomi Health Commercial |
$961.02
|
| 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 Cigna Priority Health |
$761.78
|
| Rate for Payer: Priority Health HMO/PPO |
$1,019.61
|
| Rate for Payer: Priority Health Medicare |
$295.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$785.22
|
| 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 Dual Complete DSNP |
$292.99
|
| Rate for Payer: UHC Exchange |
$292.99
|
| Rate for Payer: UHC Medicare Advantage |
$292.99
|
| Rate for Payer: VA VA |
$292.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$878.98
|
|
|
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 |
$897.04 |
| Max. Negotiated Rate |
$1,242.05 |
| Rate for Payer: Aetna Commercial |
$1,173.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.54
|
| Rate for Payer: BCN Commercial |
$1,066.51
|
| 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: PHP Commercial |
$1,173.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1,200.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$924.64
|
| 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 13 LONG TERM
|
Facility
|
OP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.76 |
| 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 |
$552.02
|
| Rate for Payer: BCBS MAPPO |
$345.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.55
|
| Rate for Payer: BCN Commercial |
$1,073.00
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Nomi Health Commercial |
$1,131.65
|
| 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 Cigna Priority Health |
$897.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1,200.65
|
| Rate for Payer: Priority Health Medicare |
$348.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$924.64
|
| 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 Dual Complete DSNP |
$345.01
|
| Rate for Payer: UHC Exchange |
$345.01
|
| Rate for Payer: UHC Medicare Advantage |
$345.01
|
| Rate for Payer: VA VA |
$345.01
|
| 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 |
$49.42 |
| 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 |
$83.23
|
| Rate for Payer: BCBS MAPPO |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$171.05
|
| Rate for Payer: BCN Commercial |
$161.77
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.86
|
| Rate for Payer: Nomi Health Commercial |
$170.62
|
| 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 Cigna Priority Health |
$135.25
|
| Rate for Payer: Priority Health HMO/PPO |
$181.02
|
| Rate for Payer: Priority Health Medicare |
$52.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.41
|
| 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 Dual Complete DSNP |
$52.02
|
| Rate for Payer: UHC Exchange |
$52.02
|
| Rate for Payer: UHC Medicare Advantage |
$52.02
|
| 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 |
$135.25 |
| Max. Negotiated Rate |
$187.26 |
| Rate for Payer: Aetna Commercial |
$176.86
|
| Rate for Payer: BCBS Trust/PPO |
$169.85
|
| Rate for Payer: BCN Commercial |
$160.80
|
| 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: PHP Commercial |
$176.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: Priority Health HMO/PPO |
$181.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.41
|
| 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
|
OP
|
$315.17
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.85 |
| 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 |
$126.07
|
| Rate for Payer: BCBS MAPPO |
$78.79
|
| Rate for Payer: BCBS Trust/PPO |
$259.10
|
| Rate for Payer: BCN Commercial |
$245.04
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: Nomi Health Commercial |
$258.44
|
| 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 Cigna Priority Health |
$204.86
|
| Rate for Payer: Priority Health HMO/PPO |
$274.20
|
| Rate for Payer: Priority Health Medicare |
$79.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.16
|
| 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 Dual Complete DSNP |
$78.79
|
| Rate for Payer: UHC Exchange |
$78.79
|
| Rate for Payer: UHC Medicare Advantage |
$78.79
|
| Rate for Payer: VA VA |
$78.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.38
|
|
|
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 |
$204.86 |
| Max. Negotiated Rate |
$283.65 |
| Rate for Payer: Aetna Commercial |
$267.89
|
| Rate for Payer: BCBS Trust/PPO |
$257.27
|
| Rate for Payer: BCN Commercial |
$243.56
|
| 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: PHP Commercial |
$267.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.86
|
| Rate for Payer: Priority Health HMO/PPO |
$274.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.16
|
| 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 4 SHORT TERM
|
Facility
|
IP
|
$422.27
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.48 |
| Max. Negotiated Rate |
$380.04 |
| Rate for Payer: Aetna Commercial |
$358.93
|
| Rate for Payer: BCBS Trust/PPO |
$344.70
|
| Rate for Payer: BCN Commercial |
$326.33
|
| 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: PHP Commercial |
$358.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.48
|
| Rate for Payer: Priority Health HMO/PPO |
$367.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.92
|
| 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 |
$100.29 |
| 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 |
$168.91
|
| Rate for Payer: BCBS MAPPO |
$105.57
|
| Rate for Payer: BCBS Trust/PPO |
$347.15
|
| Rate for Payer: BCN Commercial |
$328.31
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.93
|
| Rate for Payer: Nomi Health Commercial |
$346.26
|
| 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 Cigna Priority Health |
$274.48
|
| Rate for Payer: Priority Health HMO/PPO |
$367.37
|
| Rate for Payer: Priority Health Medicare |
$106.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.92
|
| 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 Dual Complete DSNP |
$105.57
|
| Rate for Payer: UHC Exchange |
$105.57
|
| Rate for Payer: UHC Medicare Advantage |
$105.57
|
| 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 |
$344.09 |
| Max. Negotiated Rate |
$476.43 |
| Rate for Payer: Aetna Commercial |
$449.96
|
| Rate for Payer: BCBS Trust/PPO |
$432.12
|
| Rate for Payer: BCN Commercial |
$409.10
|
| 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: PHP Commercial |
$449.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.09
|
| Rate for Payer: Priority Health HMO/PPO |
$460.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$354.68
|
| 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
|
|
