|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
OP
|
$64.35
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Aetna Commercial |
$57.91
|
| Rate for Payer: Aetna Medicare |
$23.81
|
| Rate for Payer: ASR ASR |
$62.42
|
| Rate for Payer: BCBS Complete |
$25.74
|
| Rate for Payer: BCBS Trust/PPO |
$53.06
|
| Rate for Payer: BCN Commercial |
$53.06
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Commercial |
$60.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.48
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$64.35
|
| Rate for Payer: Mclaren Commercial |
$57.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| Rate for Payer: Nomi Health Commercial |
$52.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.78
|
| Rate for Payer: Priority Health Narrow Network |
$35.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.63
|
|
|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
IP
|
$64.35
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$48.26 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Aetna Commercial |
$57.91
|
| Rate for Payer: ASR ASR |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$52.84
|
| Rate for Payer: BCN Commercial |
$52.84
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Commercial |
$60.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.48
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$64.35
|
| Rate for Payer: Mclaren Commercial |
$57.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| Rate for Payer: Nomi Health Commercial |
$52.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.63
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Trust/PPO |
$53.38
|
| Rate for Payer: BCN Commercial |
$53.38
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$63.05
|
| Rate for Payer: Healthscope Whirlpool |
$65.00
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Nomi Health Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$257.85 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: Aetna Medicare |
$21.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.76
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$53.59
|
| Rate for Payer: BCN Commercial |
$53.59
|
| Rate for Payer: BCN Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$63.05
|
| Rate for Payer: Healthscope Whirlpool |
$65.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.41
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$21.41
|
| Rate for Payer: Mclaren Medicare |
$21.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.48
|
| Rate for Payer: Meridian Medicaid |
$11.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Nomi Health Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PACE Medicare |
$20.34
|
| Rate for Payer: PACE SWMI |
$21.41
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Medicaid |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.85
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health Narrow Network |
$206.28
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.41
|
| Rate for Payer: UHC Exchange |
$33.19
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP DNSP |
$21.41
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: VA VA |
$21.41
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
OP
|
$152.77
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$152.77 |
| Rate for Payer: Aetna Commercial |
$137.49
|
| Rate for Payer: Aetna Medicare |
$56.52
|
| Rate for Payer: ASR ASR |
$148.19
|
| Rate for Payer: BCBS Complete |
$61.11
|
| Rate for Payer: BCBS Trust/PPO |
$125.96
|
| Rate for Payer: BCN Commercial |
$125.96
|
| Rate for Payer: Cash Price |
$122.22
|
| Rate for Payer: Cash Price |
$122.22
|
| Rate for Payer: Cofinity Commercial |
$143.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.22
|
| Rate for Payer: Healthscope Commercial |
$148.19
|
| Rate for Payer: Healthscope Whirlpool |
$152.77
|
| Rate for Payer: Mclaren Commercial |
$137.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.85
|
| Rate for Payer: Nomi Health Commercial |
$125.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$130.75
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.44
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
IP
|
$152.77
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$114.58 |
| Max. Negotiated Rate |
$152.77 |
| Rate for Payer: Aetna Commercial |
$137.49
|
| Rate for Payer: ASR ASR |
$148.19
|
| Rate for Payer: BCBS Trust/PPO |
$125.45
|
| Rate for Payer: BCN Commercial |
$125.45
|
| Rate for Payer: Cash Price |
$122.22
|
| Rate for Payer: Cofinity Commercial |
$143.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.22
|
| Rate for Payer: Healthscope Commercial |
$148.19
|
| Rate for Payer: Healthscope Whirlpool |
$152.77
|
| Rate for Payer: Mclaren Commercial |
$137.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.85
|
| Rate for Payer: Nomi Health Commercial |
$125.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.44
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
IP
|
$11,229.50
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,422.12 |
| Max. Negotiated Rate |
$11,229.50 |
| Rate for Payer: Aetna Commercial |
$10,106.55
|
| Rate for Payer: ASR ASR |
$10,892.61
|
| Rate for Payer: BCBS Trust/PPO |
$9,221.67
|
| Rate for Payer: BCN Commercial |
$9,221.67
|
| Rate for Payer: Cash Price |
$8,983.60
|
| Rate for Payer: Cofinity Commercial |
$10,555.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,983.60
|
| Rate for Payer: Healthscope Commercial |
$10,892.61
|
| Rate for Payer: Healthscope Whirlpool |
$11,229.50
|
| Rate for Payer: Mclaren Commercial |
$10,106.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,545.08
|
| Rate for Payer: Nomi Health Commercial |
$9,208.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,422.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,881.96
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
OP
|
$11,229.50
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,965.99 |
| Max. Negotiated Rate |
$11,229.50 |
| Rate for Payer: Aetna Commercial |
$10,106.55
|
| Rate for Payer: Aetna Medicare |
$5,671.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,088.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,088.88
|
| Rate for Payer: ASR ASR |
$10,892.61
|
| Rate for Payer: BCBS Complete |
$3,114.57
|
| Rate for Payer: BCBS MAPPO |
$5,671.10
|
| Rate for Payer: BCBS Trust/PPO |
$9,258.72
|
| Rate for Payer: BCN Commercial |
$9,258.72
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.10
|
| Rate for Payer: Cash Price |
$8,983.60
|
| Rate for Payer: Cash Price |
$8,983.60
|
| Rate for Payer: Cofinity Commercial |
$10,555.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,983.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.10
|
| Rate for Payer: Healthscope Commercial |
$10,892.61
|
| Rate for Payer: Healthscope Whirlpool |
$11,229.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,671.10
|
| Rate for Payer: Mclaren Commercial |
$10,106.55
|
| Rate for Payer: Mclaren Medicaid |
$5,671.10
|
| Rate for Payer: Mclaren Medicare |
$5,671.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,954.65
|
| Rate for Payer: Meridian Medicaid |
$3,114.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,521.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,238.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,545.08
|
| Rate for Payer: Nomi Health Commercial |
$9,208.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,422.12
|
| Rate for Payer: PACE Medicare |
$5,387.55
|
| Rate for Payer: PACE SWMI |
$5,671.10
|
| Rate for Payer: PHP Commercial |
$6,238.21
|
| Rate for Payer: PHP Medicaid |
$3,039.71
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,965.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,839.29
|
| Rate for Payer: Priority Health Medicare |
$5,671.10
|
| Rate for Payer: Priority Health Narrow Network |
$7,871.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,881.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,671.10
|
| Rate for Payer: UHC Exchange |
$8,790.20
|
| Rate for Payer: UHC Medicaid |
$2,965.99
|
| Rate for Payer: UHCCP DNSP |
$5,671.10
|
| Rate for Payer: UHCCP Medicaid |
$2,965.99
|
| Rate for Payer: VA VA |
$5,671.10
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$2,189.04
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
36100525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$820.32 |
| Max. Negotiated Rate |
$2,431.16 |
| Rate for Payer: Aetna Commercial |
$1,970.14
|
| Rate for Payer: Aetna Medicare |
$1,568.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.61
|
| Rate for Payer: ASR ASR |
$2,123.37
|
| Rate for Payer: BCBS Complete |
$861.41
|
| Rate for Payer: BCBS MAPPO |
$1,568.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,804.86
|
| Rate for Payer: BCN Commercial |
$1,804.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.49
|
| Rate for Payer: Cash Price |
$1,751.23
|
| Rate for Payer: Cash Price |
$1,751.23
|
| Rate for Payer: Cofinity Commercial |
$2,057.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.49
|
| Rate for Payer: Healthscope Commercial |
$2,123.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,189.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.49
|
| Rate for Payer: Mclaren Commercial |
$1,970.14
|
| Rate for Payer: Mclaren Medicaid |
$1,568.49
|
| Rate for Payer: Mclaren Medicare |
$1,568.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.91
|
| Rate for Payer: Meridian Medicaid |
$861.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,725.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,860.68
|
| Rate for Payer: Nomi Health Commercial |
$1,795.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.78
|
| Rate for Payer: PACE Medicare |
$1,490.07
|
| Rate for Payer: PACE SWMI |
$1,568.49
|
| Rate for Payer: PHP Commercial |
$1,725.34
|
| Rate for Payer: PHP Medicaid |
$840.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,918.04
|
| Rate for Payer: Priority Health Medicare |
$1,568.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,534.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,926.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,568.49
|
| Rate for Payer: UHC Exchange |
$2,431.16
|
| Rate for Payer: UHC Medicaid |
$820.32
|
| Rate for Payer: UHCCP DNSP |
$1,568.49
|
| Rate for Payer: UHCCP Medicaid |
$820.32
|
| Rate for Payer: VA VA |
$1,568.49
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$2,189.04
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
36100525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,641.78 |
| Max. Negotiated Rate |
$2,189.04 |
| Rate for Payer: Aetna Commercial |
$1,970.14
|
| Rate for Payer: ASR ASR |
$2,123.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,797.64
|
| Rate for Payer: BCN Commercial |
$1,797.64
|
| Rate for Payer: Cash Price |
$1,751.23
|
| Rate for Payer: Cofinity Commercial |
$2,057.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.23
|
| Rate for Payer: Healthscope Commercial |
$2,123.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,189.04
|
| Rate for Payer: Mclaren Commercial |
$1,970.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,860.68
|
| Rate for Payer: Nomi Health Commercial |
$1,795.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,926.36
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING
|
Facility
|
OP
|
$18,905.74
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
36100527
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$18,905.74 |
| Rate for Payer: Aetna Commercial |
$17,015.17
|
| Rate for Payer: Aetna Medicare |
$11,502.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: ASR ASR |
$18,338.57
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$15,587.78
|
| Rate for Payer: BCN Commercial |
$15,587.78
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$15,124.59
|
| Rate for Payer: Cash Price |
$15,124.59
|
| Rate for Payer: Cofinity Commercial |
$17,771.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,124.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$18,338.57
|
| Rate for Payer: Healthscope Whirlpool |
$18,905.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,502.68
|
| Rate for Payer: Mclaren Commercial |
$17,015.17
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$6,317.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,069.88
|
| Rate for Payer: Nomi Health Commercial |
$15,502.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,179.31
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$12,652.95
|
| Rate for Payer: PHP Medicaid |
$6,165.44
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,565.21
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Narrow Network |
$13,252.92
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,637.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Exchange |
$17,829.15
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP DNSP |
$11,502.68
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING
|
Facility
|
IP
|
$18,905.74
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
36100527
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,179.31 |
| Max. Negotiated Rate |
$18,905.74 |
| Rate for Payer: Aetna Commercial |
$17,015.17
|
| Rate for Payer: ASR ASR |
$18,338.57
|
| Rate for Payer: BCBS Trust/PPO |
$15,525.39
|
| Rate for Payer: BCN Commercial |
$15,525.39
|
| Rate for Payer: Cash Price |
$15,124.59
|
| Rate for Payer: Cofinity Commercial |
$17,771.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,124.59
|
| Rate for Payer: Healthscope Commercial |
$18,338.57
|
| Rate for Payer: Healthscope Whirlpool |
$18,905.74
|
| Rate for Payer: Mclaren Commercial |
$17,015.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,069.88
|
| Rate for Payer: Nomi Health Commercial |
$15,502.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,179.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,637.05
|
|
|
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 |
$785.58 |
| Max. Negotiated Rate |
$1,047.44 |
| Rate for Payer: Aetna Commercial |
$942.70
|
| Rate for Payer: ASR ASR |
$1,016.02
|
| Rate for Payer: BCBS Trust/PPO |
$860.16
|
| Rate for Payer: BCN Commercial |
$860.16
|
| Rate for Payer: Cash Price |
$837.95
|
| Rate for Payer: Cofinity Commercial |
$984.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$837.95
|
| Rate for Payer: Healthscope Commercial |
$1,016.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,047.44
|
| Rate for Payer: Mclaren Commercial |
$942.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.32
|
| Rate for Payer: Nomi Health Commercial |
$858.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$785.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$921.75
|
|
|
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 |
$387.55 |
| Max. Negotiated Rate |
$1,047.44 |
| Rate for Payer: Aetna Commercial |
$942.70
|
| Rate for Payer: Aetna Medicare |
$387.55
|
| Rate for Payer: ASR ASR |
$1,016.02
|
| Rate for Payer: BCBS Complete |
$418.98
|
| Rate for Payer: BCBS Trust/PPO |
$863.61
|
| Rate for Payer: BCN Commercial |
$863.61
|
| Rate for Payer: Cash Price |
$837.95
|
| Rate for Payer: Cofinity Commercial |
$984.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$837.95
|
| Rate for Payer: Healthscope Commercial |
$1,016.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,047.44
|
| Rate for Payer: Mclaren Commercial |
$942.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$837.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.32
|
| Rate for Payer: Nomi Health Commercial |
$858.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$785.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$917.77
|
| Rate for Payer: Priority Health Narrow Network |
$734.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$921.75
|
|
|
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 |
$433.63 |
| Max. Negotiated Rate |
$1,171.97 |
| Rate for Payer: Aetna Commercial |
$1,054.77
|
| Rate for Payer: Aetna Medicare |
$433.63
|
| Rate for Payer: ASR ASR |
$1,136.81
|
| Rate for Payer: BCBS Complete |
$468.79
|
| Rate for Payer: BCBS Trust/PPO |
$966.29
|
| Rate for Payer: BCN Commercial |
$966.29
|
| Rate for Payer: Cash Price |
$937.58
|
| Rate for Payer: Cofinity Commercial |
$1,101.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.58
|
| Rate for Payer: Healthscope Commercial |
$1,136.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,171.97
|
| Rate for Payer: Mclaren Commercial |
$1,054.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$937.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.17
|
| Rate for Payer: Nomi Health Commercial |
$961.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$878.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,026.88
|
| Rate for Payer: Priority Health Narrow Network |
$821.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,031.33
|
|
|
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 |
$878.98 |
| Max. Negotiated Rate |
$1,171.97 |
| Rate for Payer: Aetna Commercial |
$1,054.77
|
| Rate for Payer: ASR ASR |
$1,136.81
|
| Rate for Payer: BCBS Trust/PPO |
$962.42
|
| Rate for Payer: BCN Commercial |
$962.42
|
| Rate for Payer: Cash Price |
$937.58
|
| Rate for Payer: Cofinity Commercial |
$1,101.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.58
|
| Rate for Payer: Healthscope Commercial |
$1,136.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,171.97
|
| Rate for Payer: Mclaren Commercial |
$1,054.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.17
|
| Rate for Payer: Nomi Health Commercial |
$961.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$878.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,031.33
|
|
|
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 |
$510.62 |
| Max. Negotiated Rate |
$1,380.06 |
| Rate for Payer: Aetna Commercial |
$1,242.05
|
| Rate for Payer: Aetna Medicare |
$510.62
|
| Rate for Payer: ASR ASR |
$1,338.66
|
| Rate for Payer: BCBS Complete |
$552.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.86
|
| Rate for Payer: BCN Commercial |
$1,137.86
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,297.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,338.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,380.06
|
| Rate for Payer: Mclaren Commercial |
$1,242.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,104.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Nomi Health Commercial |
$1,131.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,209.21
|
| Rate for Payer: Priority Health Narrow Network |
$967.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,214.45
|
|
|
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 |
$1,035.05 |
| Max. Negotiated Rate |
$1,380.06 |
| Rate for Payer: Aetna Commercial |
$1,242.05
|
| Rate for Payer: ASR ASR |
$1,338.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,133.31
|
| Rate for Payer: BCN Commercial |
$1,133.31
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,297.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,338.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,380.06
|
| Rate for Payer: Mclaren Commercial |
$1,242.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Nomi Health Commercial |
$1,131.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,214.45
|
|
|
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 |
$156.05 |
| Max. Negotiated Rate |
$208.07 |
| Rate for Payer: Aetna Commercial |
$187.26
|
| Rate for Payer: ASR ASR |
$201.83
|
| Rate for Payer: BCBS Trust/PPO |
$170.87
|
| Rate for Payer: BCN Commercial |
$170.87
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$201.83
|
| Rate for Payer: Healthscope Whirlpool |
$208.07
|
| Rate for Payer: Mclaren Commercial |
$187.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.86
|
| Rate for Payer: Nomi Health Commercial |
$170.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.10
|
|
|
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 |
$76.99 |
| Max. Negotiated Rate |
$208.07 |
| Rate for Payer: Aetna Commercial |
$187.26
|
| Rate for Payer: Aetna Medicare |
$76.99
|
| Rate for Payer: ASR ASR |
$201.83
|
| Rate for Payer: BCBS Complete |
$83.23
|
| Rate for Payer: BCBS Trust/PPO |
$171.55
|
| Rate for Payer: BCN Commercial |
$171.55
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$201.83
|
| Rate for Payer: Healthscope Whirlpool |
$208.07
|
| Rate for Payer: Mclaren Commercial |
$187.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.86
|
| Rate for Payer: Nomi Health Commercial |
$170.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$182.31
|
| Rate for Payer: Priority Health Narrow Network |
$145.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.10
|
|
|
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 |
$236.38 |
| Max. Negotiated Rate |
$315.17 |
| Rate for Payer: Aetna Commercial |
$283.65
|
| Rate for Payer: ASR ASR |
$305.71
|
| Rate for Payer: BCBS Trust/PPO |
$258.82
|
| Rate for Payer: BCN Commercial |
$258.82
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cofinity Commercial |
$296.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.14
|
| Rate for Payer: Healthscope Commercial |
$305.71
|
| Rate for Payer: Healthscope Whirlpool |
$315.17
|
| Rate for Payer: Mclaren Commercial |
$283.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: Nomi Health Commercial |
$258.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.35
|
|
|
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 |
$116.61 |
| Max. Negotiated Rate |
$315.17 |
| Rate for Payer: Aetna Commercial |
$283.65
|
| Rate for Payer: Aetna Medicare |
$116.61
|
| Rate for Payer: ASR ASR |
$305.71
|
| Rate for Payer: BCBS Complete |
$126.07
|
| Rate for Payer: BCBS Trust/PPO |
$259.86
|
| Rate for Payer: BCN Commercial |
$259.86
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cofinity Commercial |
$296.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.14
|
| Rate for Payer: Healthscope Commercial |
$305.71
|
| Rate for Payer: Healthscope Whirlpool |
$315.17
|
| Rate for Payer: Mclaren Commercial |
$283.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: Nomi Health Commercial |
$258.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$276.15
|
| Rate for Payer: Priority Health Narrow Network |
$220.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.35
|
|
|
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 |
$156.24 |
| Max. Negotiated Rate |
$422.27 |
| Rate for Payer: Aetna Commercial |
$380.04
|
| Rate for Payer: Aetna Medicare |
$156.24
|
| Rate for Payer: ASR ASR |
$409.60
|
| Rate for Payer: BCBS Complete |
$168.91
|
| Rate for Payer: BCBS Trust/PPO |
$348.16
|
| Rate for Payer: BCN Commercial |
$348.16
|
| Rate for Payer: Cash Price |
$337.82
|
| Rate for Payer: Cofinity Commercial |
$396.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.82
|
| Rate for Payer: Healthscope Commercial |
$409.60
|
| Rate for Payer: Healthscope Whirlpool |
$422.27
|
| Rate for Payer: Mclaren Commercial |
$380.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.93
|
| Rate for Payer: Nomi Health Commercial |
$346.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$369.99
|
| Rate for Payer: Priority Health Narrow Network |
$296.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.60
|
|
|
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 |
$316.70 |
| Max. Negotiated Rate |
$422.27 |
| Rate for Payer: Aetna Commercial |
$380.04
|
| Rate for Payer: ASR ASR |
$409.60
|
| Rate for Payer: BCBS Trust/PPO |
$346.77
|
| Rate for Payer: BCN Commercial |
$346.77
|
| Rate for Payer: Cash Price |
$337.82
|
| Rate for Payer: Cofinity Commercial |
$396.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.82
|
| Rate for Payer: Healthscope Commercial |
$409.60
|
| Rate for Payer: Healthscope Whirlpool |
$422.27
|
| Rate for Payer: Mclaren Commercial |
$380.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.93
|
| Rate for Payer: Nomi Health Commercial |
$346.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.60
|
|
|
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 |
$195.87 |
| Max. Negotiated Rate |
$529.37 |
| Rate for Payer: Aetna Commercial |
$476.43
|
| Rate for Payer: Aetna Medicare |
$195.87
|
| Rate for Payer: ASR ASR |
$513.49
|
| Rate for Payer: BCBS Complete |
$211.75
|
| Rate for Payer: BCBS Trust/PPO |
$436.47
|
| Rate for Payer: BCN Commercial |
$436.47
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cofinity Commercial |
$497.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.50
|
| Rate for Payer: Healthscope Commercial |
$513.49
|
| Rate for Payer: Healthscope Whirlpool |
$529.37
|
| Rate for Payer: Mclaren Commercial |
$476.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$423.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.96
|
| Rate for Payer: Nomi Health Commercial |
$434.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$463.83
|
| Rate for Payer: Priority Health Narrow Network |
$371.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$465.85
|
|
