|
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 |
$345.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.55
|
| Rate for Payer: BCN Commercial |
$1,073.00
|
| Rate for Payer: BCN Medicare Advantage |
$345.02
|
| 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 |
$345.02
|
| Rate for Payer: Healthscope Commercial |
$1,242.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.04
|
| 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 |
$345.02
|
| Rate for Payer: PHP Commercial |
$1,173.05
|
| Rate for Payer: PHP Medicare Advantage |
$345.02
|
| 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 |
$345.02
|
| 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 |
$345.02
|
| Rate for Payer: UHC Exchange |
$345.02
|
| Rate for Payer: UHC Medicare Advantage |
$345.02
|
| Rate for Payer: VA VA |
$345.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.04
|
|
|
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 |
$1,035.04
|
| 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 |
$1,035.04
|
|
|
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 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 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 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 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
|
OP
|
$529.37
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.73 |
| 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 |
$211.75
|
| Rate for Payer: BCBS MAPPO |
$132.34
|
| Rate for Payer: BCBS Trust/PPO |
$435.20
|
| Rate for Payer: BCN Commercial |
$411.59
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.96
|
| Rate for Payer: Nomi Health Commercial |
$434.08
|
| 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 Cigna Priority Health |
$344.09
|
| Rate for Payer: Priority Health HMO/PPO |
$460.55
|
| Rate for Payer: Priority Health Medicare |
$133.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$354.68
|
| 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 Dual Complete DSNP |
$132.34
|
| Rate for Payer: UHC Exchange |
$132.34
|
| Rate for Payer: UHC Medicare Advantage |
$132.34
|
| Rate for Payer: VA VA |
$132.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.03
|
|
|
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
|
|
|
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 |
$176.60 |
| 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 |
$297.43
|
| Rate for Payer: BCBS MAPPO |
$185.89
|
| Rate for Payer: BCBS Trust/PPO |
$611.29
|
| Rate for Payer: BCN Commercial |
$578.13
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.03
|
| Rate for Payer: Nomi Health Commercial |
$609.73
|
| 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 Cigna Priority Health |
$483.32
|
| Rate for Payer: Priority Health HMO/PPO |
$646.91
|
| Rate for Payer: Priority Health Medicare |
$187.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$498.19
|
| 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 Dual Complete DSNP |
$185.89
|
| Rate for Payer: UHC Exchange |
$185.89
|
| Rate for Payer: UHC Medicare Advantage |
$185.89
|
| 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 |
$483.32 |
| Max. Negotiated Rate |
$669.21 |
| Rate for Payer: Aetna Commercial |
$632.03
|
| Rate for Payer: BCBS Trust/PPO |
$606.98
|
| Rate for Payer: BCN Commercial |
$574.63
|
| 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: PHP Commercial |
$632.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.32
|
| Rate for Payer: Priority Health HMO/PPO |
$646.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$498.19
|
| 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 |
$515.65 |
| Max. Negotiated Rate |
$713.98 |
| Rate for Payer: Aetna Commercial |
$674.31
|
| Rate for Payer: BCBS Trust/PPO |
$647.58
|
| Rate for Payer: BCN Commercial |
$613.07
|
| 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: PHP Commercial |
$674.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.65
|
| Rate for Payer: Priority Health HMO/PPO |
$690.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.52
|
| 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 |
$188.41 |
| 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 |
$317.32
|
| Rate for Payer: BCBS MAPPO |
$198.33
|
| Rate for Payer: BCBS Trust/PPO |
$652.18
|
| Rate for Payer: BCN Commercial |
$616.80
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.31
|
| Rate for Payer: Nomi Health Commercial |
$650.51
|
| 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 Cigna Priority Health |
$515.65
|
| Rate for Payer: Priority Health HMO/PPO |
$690.18
|
| Rate for Payer: Priority Health Medicare |
$200.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.52
|
| 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 Dual Complete DSNP |
$198.33
|
| Rate for Payer: UHC Exchange |
$198.33
|
| Rate for Payer: UHC Medicare Advantage |
$198.33
|
| 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 |
$202.03 |
| 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 |
$340.27
|
| Rate for Payer: BCBS MAPPO |
$212.67
|
| Rate for Payer: BCBS Trust/PPO |
$699.34
|
| Rate for Payer: BCN Commercial |
$661.40
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.07
|
| Rate for Payer: Nomi Health Commercial |
$697.55
|
| 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 Cigna Priority Health |
$552.94
|
| Rate for Payer: Priority Health HMO/PPO |
$740.08
|
| Rate for Payer: Priority Health Medicare |
$214.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$569.95
|
| 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 Dual Complete DSNP |
$212.67
|
| Rate for Payer: UHC Exchange |
$212.67
|
| Rate for Payer: UHC Medicare Advantage |
$212.67
|
| 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 |
$552.94 |
| Max. Negotiated Rate |
$765.60 |
| Rate for Payer: Aetna Commercial |
$723.07
|
| Rate for Payer: BCBS Trust/PPO |
$694.40
|
| Rate for Payer: BCN Commercial |
$657.40
|
| 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: PHP Commercial |
$723.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.94
|
| Rate for Payer: Priority Health HMO/PPO |
$740.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$569.95
|
| 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
|
OP
|
$957.77
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.47 |
| 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 |
$383.11
|
| Rate for Payer: BCBS MAPPO |
$239.44
|
| Rate for Payer: BCBS Trust/PPO |
$787.38
|
| Rate for Payer: BCN Commercial |
$744.67
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.10
|
| Rate for Payer: Nomi Health Commercial |
$785.37
|
| 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 Cigna Priority Health |
$622.55
|
| Rate for Payer: Priority Health HMO/PPO |
$833.26
|
| Rate for Payer: Priority Health Medicare |
$241.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$641.71
|
| 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 Dual Complete DSNP |
$239.44
|
| Rate for Payer: UHC Exchange |
$239.44
|
| Rate for Payer: UHC Medicare Advantage |
$239.44
|
| Rate for Payer: VA VA |
$239.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.33
|
|
|
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 |
$622.55 |
| Max. Negotiated Rate |
$861.99 |
| Rate for Payer: Aetna Commercial |
$814.10
|
| Rate for Payer: BCBS Trust/PPO |
$781.83
|
| Rate for Payer: BCN Commercial |
$740.16
|
| 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: PHP Commercial |
$814.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.55
|
| Rate for Payer: Priority Health HMO/PPO |
$833.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$641.71
|
| 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 DIFFUSION
|
Facility
|
OP
|
$396.56
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.18 |
| Max. Negotiated Rate |
$356.90 |
| Rate for Payer: Aetna Commercial |
$337.08
|
| Rate for Payer: Aetna Medicare |
$103.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.92
|
| Rate for Payer: BCBS Complete |
$158.62
|
| Rate for Payer: BCBS MAPPO |
$99.14
|
| Rate for Payer: BCBS Trust/PPO |
$326.01
|
| Rate for Payer: BCN Commercial |
$308.33
|
| Rate for Payer: BCN Medicare Advantage |
$99.14
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cofinity Commercial |
$341.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.14
|
| Rate for Payer: Healthscope Commercial |
$356.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.08
|
| Rate for Payer: Nomi Health Commercial |
$325.18
|
| Rate for Payer: PACE Senior Care Partners |
$94.18
|
| Rate for Payer: PACE SWMI |
$99.14
|
| Rate for Payer: PHP Commercial |
$337.08
|
| Rate for Payer: PHP Medicare Advantage |
$99.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.76
|
| Rate for Payer: Priority Health HMO/PPO |
$345.01
|
| Rate for Payer: Priority Health Medicare |
$100.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.70
|
| Rate for Payer: Railroad Medicare Medicare |
$99.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.97
|
| Rate for Payer: UHC Core |
$331.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.14
|
| Rate for Payer: UHC Exchange |
$99.14
|
| Rate for Payer: UHC Medicare Advantage |
$99.14
|
| Rate for Payer: VA VA |
$99.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.42
|
|
|
HC DIFFUSION
|
Facility
|
IP
|
$396.56
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$257.76 |
| Max. Negotiated Rate |
$356.90 |
| Rate for Payer: Aetna Commercial |
$337.08
|
| Rate for Payer: BCBS Trust/PPO |
$323.71
|
| Rate for Payer: BCN Commercial |
$306.46
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cofinity Commercial |
$341.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.25
|
| Rate for Payer: Healthscope Commercial |
$356.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.08
|
| Rate for Payer: Nomi Health Commercial |
$325.18
|
| Rate for Payer: PHP Commercial |
$337.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.76
|
| Rate for Payer: Priority Health HMO/PPO |
$345.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.97
|
| Rate for Payer: UHC Core |
$331.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.42
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
IP
|
$169.32
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$110.06 |
| Max. Negotiated Rate |
$152.39 |
| Rate for Payer: Aetna Commercial |
$143.92
|
| Rate for Payer: BCBS Trust/PPO |
$138.22
|
| Rate for Payer: BCN Commercial |
$130.85
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cofinity Commercial |
$145.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Healthscope Commercial |
$152.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.92
|
| Rate for Payer: Nomi Health Commercial |
$138.84
|
| Rate for Payer: PHP Commercial |
$143.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: Priority Health HMO/PPO |
$147.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.00
|
| Rate for Payer: UHC Core |
$141.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.99
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
OP
|
$169.32
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$152.39 |
| Rate for Payer: Aetna Commercial |
$143.92
|
| Rate for Payer: Aetna Medicare |
$44.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.91
|
| Rate for Payer: BCBS Complete |
$26.43
|
| Rate for Payer: BCBS MAPPO |
$42.33
|
| Rate for Payer: BCBS Trust/PPO |
$139.20
|
| Rate for Payer: BCN Commercial |
$131.65
|
| Rate for Payer: BCN Medicare Advantage |
$42.33
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cofinity Commercial |
$145.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.33
|
| Rate for Payer: Healthscope Commercial |
$152.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.99
|
| Rate for Payer: Mclaren Medicaid |
$25.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.45
|
| Rate for Payer: Meridian Medicaid |
$26.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.92
|
| Rate for Payer: Nomi Health Commercial |
$138.84
|
| Rate for Payer: PACE Senior Care Partners |
$40.21
|
| Rate for Payer: PACE SWMI |
$42.33
|
| Rate for Payer: PHP Commercial |
$143.92
|
| Rate for Payer: PHP Medicare Advantage |
$42.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: Priority Health HMO/PPO |
$147.31
|
| Rate for Payer: Priority Health Medicare |
$42.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.44
|
| Rate for Payer: Railroad Medicare Medicare |
$42.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.00
|
| Rate for Payer: UHC Core |
$141.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.33
|
| Rate for Payer: UHC Exchange |
$42.33
|
| Rate for Payer: UHC Medicare Advantage |
$42.33
|
| Rate for Payer: UHCCP Medicaid |
$25.17
|
| Rate for Payer: VA VA |
$42.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.99
|
|
|
HC DIGOXIN LVL
|
Facility
|
IP
|
$91.87
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.72 |
| Max. Negotiated Rate |
$82.68 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: BCBS Trust/PPO |
$74.99
|
| Rate for Payer: BCN Commercial |
$71.00
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Healthscope Commercial |
$82.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: Nomi Health Commercial |
$75.33
|
| Rate for Payer: PHP Commercial |
$78.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: Priority Health HMO/PPO |
$79.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.85
|
| Rate for Payer: UHC Core |
$76.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.90
|
|
|
HC DIGOXIN LVL
|
Facility
|
OP
|
$91.87
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$82.68 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna Medicare |
$23.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.71
|
| Rate for Payer: BCBS Complete |
$10.08
|
| Rate for Payer: BCBS MAPPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$75.53
|
| Rate for Payer: BCN Commercial |
$71.43
|
| Rate for Payer: BCN Medicare Advantage |
$22.97
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$82.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.90
|
| Rate for Payer: Mclaren Medicaid |
$9.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.12
|
| Rate for Payer: Meridian Medicaid |
$10.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: Nomi Health Commercial |
$75.33
|
| Rate for Payer: PACE Senior Care Partners |
$21.82
|
| Rate for Payer: PACE SWMI |
$22.97
|
| Rate for Payer: PHP Commercial |
$78.09
|
| Rate for Payer: PHP Medicare Advantage |
$22.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: Priority Health HMO/PPO |
$79.93
|
| Rate for Payer: Priority Health Medicare |
$23.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.55
|
| Rate for Payer: Railroad Medicare Medicare |
$22.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.85
|
| Rate for Payer: UHC Core |
$76.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.97
|
| Rate for Payer: UHC Exchange |
$22.97
|
| Rate for Payer: UHC Medicare Advantage |
$22.97
|
| Rate for Payer: UHCCP Medicaid |
$9.60
|
| Rate for Payer: VA VA |
$22.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.90
|
|
|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$28.14
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
