|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
IP
|
$34.78
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$31.30 |
| Rate for Payer: Aetna Commercial |
$29.56
|
| Rate for Payer: BCBS Trust/PPO |
$26.88
|
| Rate for Payer: BCN Commercial |
$26.88
|
| Rate for Payer: Cash Price |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$29.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.82
|
| Rate for Payer: Healthscope Commercial |
$31.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.56
|
| Rate for Payer: PHP Commercial |
$29.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.61
|
| Rate for Payer: UHC Core |
$29.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.08
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
IP
|
$3,822.09
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,331.09 |
| Max. Negotiated Rate |
$3,439.88 |
| Rate for Payer: Aetna Commercial |
$3,248.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,953.71
|
| Rate for Payer: BCN Commercial |
$2,953.71
|
| Rate for Payer: Cash Price |
$3,057.67
|
| Rate for Payer: Cofinity Commercial |
$3,287.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,057.67
|
| Rate for Payer: Healthscope Commercial |
$3,439.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,866.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,248.78
|
| Rate for Payer: PHP Commercial |
$3,248.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,675.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,325.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,331.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,363.44
|
| Rate for Payer: UHC Core |
$3,191.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,866.57
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
OP
|
$3,822.09
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$907.75 |
| Max. Negotiated Rate |
$3,439.88 |
| Rate for Payer: Aetna Commercial |
$3,248.78
|
| Rate for Payer: Aetna Medicare |
$993.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,194.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,194.40
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$955.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,971.67
|
| Rate for Payer: BCN Commercial |
$2,971.67
|
| Rate for Payer: BCN Medicare Advantage |
$955.52
|
| Rate for Payer: Cash Price |
$3,057.67
|
| Rate for Payer: Cash Price |
$3,057.67
|
| Rate for Payer: Cofinity Commercial |
$3,287.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,057.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$955.52
|
| Rate for Payer: Healthscope Commercial |
$3,439.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,866.57
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,003.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,098.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,248.78
|
| Rate for Payer: PACE Senior Care Partners |
$907.75
|
| Rate for Payer: PACE SWMI |
$955.52
|
| Rate for Payer: PHP Commercial |
$3,248.78
|
| Rate for Payer: PHP Medicare Advantage |
$955.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,675.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,325.22
|
| Rate for Payer: Priority Health Medicare |
$955.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,331.09
|
| Rate for Payer: Railroad Medicare Medicare |
$955.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,363.44
|
| Rate for Payer: UHC Core |
$3,191.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$955.52
|
| Rate for Payer: UHC Medicare Advantage |
$984.19
|
| Rate for Payer: VA VA |
$955.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,866.57
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
IP
|
$24,183.90
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$14,749.76 |
| Max. Negotiated Rate |
$21,765.51 |
| Rate for Payer: Aetna Commercial |
$20,556.32
|
| Rate for Payer: BCBS Trust/PPO |
$18,689.32
|
| Rate for Payer: BCN Commercial |
$18,689.32
|
| Rate for Payer: Cash Price |
$19,347.12
|
| Rate for Payer: Cofinity Commercial |
$20,798.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,347.12
|
| Rate for Payer: Healthscope Commercial |
$21,765.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,137.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,556.32
|
| Rate for Payer: PHP Commercial |
$20,556.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,928.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,039.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,749.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,281.83
|
| Rate for Payer: UHC Core |
$20,193.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,137.92
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
OP
|
$24,183.90
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,743.68 |
| Max. Negotiated Rate |
$21,765.51 |
| Rate for Payer: Aetna Commercial |
$20,556.32
|
| Rate for Payer: Aetna Medicare |
$6,287.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,557.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,557.47
|
| Rate for Payer: BCBS Complete |
$7,577.51
|
| Rate for Payer: BCBS MAPPO |
$6,045.98
|
| Rate for Payer: BCBS Trust/PPO |
$18,802.98
|
| Rate for Payer: BCN Commercial |
$18,802.98
|
| Rate for Payer: BCN Medicare Advantage |
$6,045.98
|
| Rate for Payer: Cash Price |
$19,347.12
|
| Rate for Payer: Cash Price |
$19,347.12
|
| Rate for Payer: Cofinity Commercial |
$20,798.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,347.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,045.98
|
| Rate for Payer: Healthscope Commercial |
$21,765.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,137.92
|
| Rate for Payer: Mclaren Medicaid |
$7,216.67
|
| Rate for Payer: Meridian Medicaid |
$7,577.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,348.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,952.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,556.32
|
| Rate for Payer: PACE Senior Care Partners |
$5,743.68
|
| Rate for Payer: PACE SWMI |
$6,045.98
|
| Rate for Payer: PHP Commercial |
$20,556.32
|
| Rate for Payer: PHP Medicare Advantage |
$6,045.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,216.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,928.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,039.99
|
| Rate for Payer: Priority Health Medicare |
$6,045.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,749.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6,045.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,281.83
|
| Rate for Payer: UHC Core |
$20,193.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,045.98
|
| Rate for Payer: UHC Medicare Advantage |
$6,227.35
|
| Rate for Payer: VA VA |
$6,045.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,137.92
|
|
|
HC DEVELOPMENTAL TESTING
|
Facility
|
IP
|
$371.75
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
51000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.73 |
| Max. Negotiated Rate |
$334.58 |
| Rate for Payer: Aetna Commercial |
$315.99
|
| Rate for Payer: BCBS Trust/PPO |
$287.29
|
| Rate for Payer: BCN Commercial |
$287.29
|
| Rate for Payer: Cash Price |
$297.40
|
| Rate for Payer: Cofinity Commercial |
$319.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.40
|
| Rate for Payer: Healthscope Commercial |
$334.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.99
|
| Rate for Payer: PHP Commercial |
$315.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.14
|
| Rate for Payer: UHC Core |
$310.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.81
|
|
|
HC DEVELOPMENTAL TESTING
|
Facility
|
OP
|
$371.75
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
51000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.29 |
| Max. Negotiated Rate |
$334.58 |
| Rate for Payer: Aetna Commercial |
$315.99
|
| Rate for Payer: Aetna Medicare |
$96.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.17
|
| Rate for Payer: BCBS Complete |
$148.70
|
| Rate for Payer: BCBS MAPPO |
$92.94
|
| Rate for Payer: BCBS Trust/PPO |
$289.04
|
| Rate for Payer: BCN Commercial |
$289.04
|
| Rate for Payer: BCN Medicare Advantage |
$92.94
|
| Rate for Payer: Cash Price |
$297.40
|
| Rate for Payer: Cofinity Commercial |
$319.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.94
|
| Rate for Payer: Healthscope Commercial |
$334.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$97.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.99
|
| Rate for Payer: PACE Senior Care Partners |
$88.29
|
| Rate for Payer: PACE SWMI |
$92.94
|
| Rate for Payer: PHP Commercial |
$315.99
|
| Rate for Payer: PHP Medicare Advantage |
$92.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.42
|
| Rate for Payer: Priority Health Medicare |
$92.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: Railroad Medicare Medicare |
$92.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.14
|
| Rate for Payer: UHC Core |
$310.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.94
|
| Rate for Payer: UHC Medicare Advantage |
$95.73
|
| Rate for Payer: VA VA |
$92.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.81
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Facility
|
IP
|
$949.00
|
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$578.80 |
| Max. Negotiated Rate |
$854.10 |
| Rate for Payer: Aetna Commercial |
$806.65
|
| Rate for Payer: BCBS Trust/PPO |
$733.39
|
| Rate for Payer: BCN Commercial |
$733.39
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$816.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.20
|
| Rate for Payer: Healthscope Commercial |
$854.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$806.65
|
| Rate for Payer: PHP Commercial |
$806.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$664.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$825.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.12
|
| Rate for Payer: UHC Core |
$792.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.75
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Professional
|
Both
|
$949.00
|
|
|
Service Code
|
HCPCS 00615
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$379.60 |
| Max. Negotiated Rate |
$664.30 |
| Rate for Payer: BCBS Complete |
$379.60
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$664.30
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Professional
|
Both
|
$949.00
|
|
|
Service Code
|
HCPCS 00615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$379.60 |
| Max. Negotiated Rate |
$664.30 |
| Rate for Payer: BCBS Complete |
$379.60
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$664.30
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Facility
|
OP
|
$949.00
|
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$225.39 |
| Max. Negotiated Rate |
$854.10 |
| Rate for Payer: Aetna Commercial |
$806.65
|
| Rate for Payer: Aetna Medicare |
$246.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.56
|
| Rate for Payer: BCBS Complete |
$379.60
|
| Rate for Payer: BCBS MAPPO |
$237.25
|
| Rate for Payer: BCBS Trust/PPO |
$737.85
|
| Rate for Payer: BCN Commercial |
$737.85
|
| Rate for Payer: BCN Medicare Advantage |
$237.25
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$816.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.25
|
| Rate for Payer: Healthscope Commercial |
$854.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$249.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$806.65
|
| Rate for Payer: PACE Senior Care Partners |
$225.39
|
| Rate for Payer: PACE SWMI |
$237.25
|
| Rate for Payer: PHP Commercial |
$806.65
|
| Rate for Payer: PHP Medicare Advantage |
$237.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$664.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$825.63
|
| Rate for Payer: Priority Health Medicare |
$237.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.80
|
| Rate for Payer: Railroad Medicare Medicare |
$237.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.12
|
| Rate for Payer: UHC Core |
$792.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.25
|
| Rate for Payer: UHC Medicare Advantage |
$244.37
|
| Rate for Payer: VA VA |
$237.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.75
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 00616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: BCBS Complete |
$124.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Facility
|
OP
|
$310.00
|
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.62 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna Commercial |
$263.50
|
| Rate for Payer: Aetna Medicare |
$80.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.88
|
| Rate for Payer: BCBS Complete |
$124.00
|
| Rate for Payer: BCBS MAPPO |
$77.50
|
| Rate for Payer: BCBS Trust/PPO |
$241.02
|
| Rate for Payer: BCN Commercial |
$241.02
|
| Rate for Payer: BCN Medicare Advantage |
$77.50
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$266.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.50
|
| Rate for Payer: Healthscope Commercial |
$279.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.50
|
| Rate for Payer: PACE Senior Care Partners |
$73.62
|
| Rate for Payer: PACE SWMI |
$77.50
|
| Rate for Payer: PHP Commercial |
$263.50
|
| Rate for Payer: PHP Medicare Advantage |
$77.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.70
|
| Rate for Payer: Priority Health Medicare |
$77.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.07
|
| Rate for Payer: Railroad Medicare Medicare |
$77.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.80
|
| Rate for Payer: UHC Core |
$258.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.50
|
| Rate for Payer: UHC Medicare Advantage |
$79.82
|
| Rate for Payer: VA VA |
$77.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.50
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Facility
|
IP
|
$310.00
|
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$189.07 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna Commercial |
$263.50
|
| Rate for Payer: BCBS Trust/PPO |
$239.57
|
| Rate for Payer: BCN Commercial |
$239.57
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$266.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Healthscope Commercial |
$279.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.50
|
| Rate for Payer: PHP Commercial |
$263.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.80
|
| Rate for Payer: UHC Core |
$258.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.50
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 00616
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: BCBS Complete |
$124.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
|
|
HC DEVICE NOT RETURNED APNEALINK
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
HCPCS 00602
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$331.20 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.60
|
|
|
HC DEVICE NOT RETURNED APNEALINK PLUS
|
Facility
|
OP
|
$1,548.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$367.65 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Aetna Medicare |
$402.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$483.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$483.75
|
| Rate for Payer: BCBS Complete |
$619.20
|
| Rate for Payer: BCBS MAPPO |
$387.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.57
|
| Rate for Payer: BCN Commercial |
$1,203.57
|
| Rate for Payer: BCN Medicare Advantage |
$387.00
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.00
|
| Rate for Payer: Healthscope Commercial |
$1,393.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,161.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$406.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$445.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,315.80
|
| Rate for Payer: PACE Senior Care Partners |
$367.65
|
| Rate for Payer: PACE SWMI |
$387.00
|
| Rate for Payer: PHP Commercial |
$1,315.80
|
| Rate for Payer: PHP Medicare Advantage |
$387.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,346.76
|
| Rate for Payer: Priority Health Medicare |
$387.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$944.13
|
| Rate for Payer: Railroad Medicare Medicare |
$387.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,362.24
|
| Rate for Payer: UHC Core |
$1,292.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.00
|
| Rate for Payer: UHC Medicare Advantage |
$398.61
|
| Rate for Payer: VA VA |
$387.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,161.00
|
|
|
HC DEVICE NOT RETURNED APNEALINK PLUS
|
Professional
|
Both
|
$1,548.00
|
|
|
Service Code
|
HCPCS 00603
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$619.20 |
| Max. Negotiated Rate |
$1,083.60 |
| Rate for Payer: BCBS Complete |
$619.20
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.60
|
|
|
HC DEVICE NOT RETURNED APNEALINK PLUS
|
Facility
|
IP
|
$1,548.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$944.13 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,196.29
|
| Rate for Payer: BCN Commercial |
$1,196.29
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Healthscope Commercial |
$1,393.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,161.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,315.80
|
| Rate for Payer: PHP Commercial |
$1,315.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,346.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$944.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,362.24
|
| Rate for Payer: UHC Core |
$1,292.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,161.00
|
|
|
HC DEVICE NOT RETURNED APNEALINK PLUS
|
Professional
|
Both
|
$1,548.00
|
|
|
Service Code
|
HCPCS 00603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$619.20 |
| Max. Negotiated Rate |
$1,083.60 |
| Rate for Payer: BCBS Complete |
$619.20
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.60
|
|
|
HC DEVICE NOT RETURNED CADD PUMP
|
Facility
|
OP
|
$3,723.00
|
|
| Hospital Charge Code |
27000642
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$884.21 |
| Max. Negotiated Rate |
$3,350.70 |
| Rate for Payer: Aetna Commercial |
$3,164.55
|
| Rate for Payer: Aetna Medicare |
$967.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,163.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,163.44
|
| Rate for Payer: BCBS Complete |
$1,489.20
|
| Rate for Payer: BCBS MAPPO |
$930.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,894.63
|
| Rate for Payer: BCN Commercial |
$2,894.63
|
| Rate for Payer: BCN Medicare Advantage |
$930.75
|
| Rate for Payer: Cash Price |
$2,978.40
|
| Rate for Payer: Cofinity Commercial |
$3,201.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,978.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$930.75
|
| Rate for Payer: Healthscope Commercial |
$3,350.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,792.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$977.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,070.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,164.55
|
| Rate for Payer: PACE Senior Care Partners |
$884.21
|
| Rate for Payer: PACE SWMI |
$930.75
|
| Rate for Payer: PHP Commercial |
$3,164.55
|
| Rate for Payer: PHP Medicare Advantage |
$930.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,606.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,239.01
|
| Rate for Payer: Priority Health Medicare |
$930.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,270.66
|
| Rate for Payer: Railroad Medicare Medicare |
$930.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,276.24
|
| Rate for Payer: UHC Core |
$3,108.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$930.75
|
| Rate for Payer: UHC Medicare Advantage |
$958.67
|
| Rate for Payer: VA VA |
$930.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,792.25
|
|
|
HC DEVICE NOT RETURNED CADD PUMP
|
Facility
|
IP
|
$3,723.00
|
|
| Hospital Charge Code |
27000642
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,270.66 |
| Max. Negotiated Rate |
$3,350.70 |
| Rate for Payer: Aetna Commercial |
$3,164.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,877.13
|
| Rate for Payer: BCN Commercial |
$2,877.13
|
| Rate for Payer: Cash Price |
$2,978.40
|
| Rate for Payer: Cofinity Commercial |
$3,201.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,978.40
|
| Rate for Payer: Healthscope Commercial |
$3,350.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,792.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,164.55
|
| Rate for Payer: PHP Commercial |
$3,164.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,606.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,239.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,270.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,276.24
|
| Rate for Payer: UHC Core |
$3,108.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,792.25
|
|
|
HC DEVICE NOT RETURNED RU SLEEPING
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 00614
|
| Hospital Charge Code |
27000614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.50
|
|
|
HC DEVICE NOT RETURNED RU SLEEPING
|
Facility
|
OP
|
$495.00
|
|
| Hospital Charge Code |
27000614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.56 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna Commercial |
$420.75
|
| Rate for Payer: Aetna Medicare |
$128.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.69
|
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: BCBS MAPPO |
$123.75
|
| Rate for Payer: BCBS Trust/PPO |
$384.86
|
| Rate for Payer: BCN Commercial |
$384.86
|
| Rate for Payer: BCN Medicare Advantage |
$123.75
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$425.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.75
|
| Rate for Payer: Healthscope Commercial |
$445.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$129.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.75
|
| Rate for Payer: PACE Senior Care Partners |
$117.56
|
| Rate for Payer: PACE SWMI |
$123.75
|
| Rate for Payer: PHP Commercial |
$420.75
|
| Rate for Payer: PHP Medicare Advantage |
$123.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.65
|
| Rate for Payer: Priority Health Medicare |
$123.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.90
|
| Rate for Payer: Railroad Medicare Medicare |
$123.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.60
|
| Rate for Payer: UHC Core |
$413.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.75
|
| Rate for Payer: UHC Medicare Advantage |
$127.46
|
| Rate for Payer: VA VA |
$123.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.25
|
|
|
HC DEVICE NOT RETURNED RU SLEEPING
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 00614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.50
|
|
