|
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 |
$254.85
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| 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 |
$201.50
|
| Rate for Payer: Priority Health HMO/PPO |
$269.70
|
| Rate for Payer: Priority Health Medicare |
$78.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.70
|
| 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 Exchange |
$77.50
|
| Rate for Payer: UHC Medicare Advantage |
$77.50
|
| 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
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 00616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 00616
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Facility
|
IP
|
$310.00
|
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna Commercial |
$263.50
|
| Rate for Payer: BCBS Trust/PPO |
$253.05
|
| 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 Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| Rate for Payer: PHP Commercial |
$263.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health HMO/PPO |
$269.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.70
|
| 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 APNEALINK
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 00602
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$549.25 |
| Rate for Payer: Aetna Medicare |
$422.50
|
| Rate for Payer: BCBS Complete |
$338.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.25
|
|
|
HC DEVICE NOT RETURNED APNEALINK PLUS
|
Professional
|
Both
|
$1,579.00
|
|
|
Service Code
|
HCPCS 00603
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$631.60 |
| Max. Negotiated Rate |
$1,026.35 |
| Rate for Payer: Aetna Medicare |
$789.50
|
| Rate for Payer: BCBS Complete |
$631.60
|
| Rate for Payer: Cash Price |
$1,263.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,026.35
|
|
|
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 |
$1,272.61
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$445.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| 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 |
$1,006.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,346.76
|
| Rate for Payer: Priority Health Medicare |
$390.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,037.16
|
| 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 Exchange |
$387.00
|
| Rate for Payer: UHC Medicare Advantage |
$387.00
|
| 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
|
Facility
|
IP
|
$1,548.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,006.20 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.63
|
| 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 Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| Rate for Payer: PHP Commercial |
$1,315.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,346.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,037.16
|
| 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
|
$1,579.00
|
|
|
Service Code
|
HCPCS 00603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$631.60 |
| Max. Negotiated Rate |
$1,026.35 |
| Rate for Payer: Aetna Medicare |
$789.50
|
| Rate for Payer: BCBS Complete |
$631.60
|
| Rate for Payer: Cash Price |
$1,263.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,026.35
|
|
|
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 |
$3,060.68
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,070.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,164.55
|
| Rate for Payer: Nomi Health Commercial |
$3,052.86
|
| 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 |
$2,419.95
|
| Rate for Payer: Priority Health HMO/PPO |
$3,239.01
|
| Rate for Payer: Priority Health Medicare |
$940.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,494.41
|
| 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 Exchange |
$930.75
|
| Rate for Payer: UHC Medicare Advantage |
$930.75
|
| 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 |
$2,419.95 |
| Max. Negotiated Rate |
$3,350.70 |
| Rate for Payer: Aetna Commercial |
$3,164.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,039.08
|
| 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 Commercial |
$3,164.55
|
| Rate for Payer: Nomi Health Commercial |
$3,052.86
|
| Rate for Payer: PHP Commercial |
$3,164.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,419.95
|
| Rate for Payer: Priority Health HMO/PPO |
$3,239.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,494.41
|
| 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 HOLTER MONITOR
|
Facility
|
IP
|
$652.00
|
|
| Hospital Charge Code |
27000705
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$423.80 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Aetna Commercial |
$554.20
|
| Rate for Payer: BCBS Trust/PPO |
$532.23
|
| Rate for Payer: BCN Commercial |
$503.87
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cofinity Commercial |
$560.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.60
|
| Rate for Payer: Healthscope Commercial |
$586.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$489.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.20
|
| Rate for Payer: Nomi Health Commercial |
$534.64
|
| Rate for Payer: PHP Commercial |
$554.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.80
|
| Rate for Payer: Priority Health HMO/PPO |
$567.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$436.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.76
|
| Rate for Payer: UHC Core |
$544.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$489.00
|
|
|
HC DEVICE NOT RETURNED HOLTER MONITOR
|
Facility
|
OP
|
$652.00
|
|
| Hospital Charge Code |
27000705
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.85 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Aetna Commercial |
$554.20
|
| Rate for Payer: Aetna Medicare |
$169.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$203.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$203.75
|
| Rate for Payer: BCBS Complete |
$260.80
|
| Rate for Payer: BCBS MAPPO |
$163.00
|
| Rate for Payer: BCBS Trust/PPO |
$536.01
|
| Rate for Payer: BCN Commercial |
$506.93
|
| Rate for Payer: BCN Medicare Advantage |
$163.00
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cofinity Commercial |
$560.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.00
|
| Rate for Payer: Healthscope Commercial |
$586.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$489.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.20
|
| Rate for Payer: Nomi Health Commercial |
$534.64
|
| Rate for Payer: PACE Senior Care Partners |
$154.85
|
| Rate for Payer: PACE SWMI |
$163.00
|
| Rate for Payer: PHP Commercial |
$554.20
|
| Rate for Payer: PHP Medicare Advantage |
$163.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.80
|
| Rate for Payer: Priority Health HMO/PPO |
$567.24
|
| Rate for Payer: Priority Health Medicare |
$164.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$436.84
|
| Rate for Payer: Railroad Medicare Medicare |
$163.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.76
|
| Rate for Payer: UHC Core |
$544.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.00
|
| Rate for Payer: UHC Exchange |
$163.00
|
| Rate for Payer: UHC Medicare Advantage |
$163.00
|
| Rate for Payer: VA VA |
$163.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$489.00
|
|
|
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 |
$406.94
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| 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 |
$321.75
|
| Rate for Payer: Priority Health HMO/PPO |
$430.65
|
| Rate for Payer: Priority Health Medicare |
$124.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.65
|
| 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 Exchange |
$123.75
|
| Rate for Payer: UHC Medicare Advantage |
$123.75
|
| Rate for Payer: VA VA |
$123.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.25
|
|
|
HC DEVICE NOT RETURNED RU SLEEPING
|
Facility
|
IP
|
$495.00
|
|
| Hospital Charge Code |
27000614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna Commercial |
$420.75
|
| Rate for Payer: BCBS Trust/PPO |
$404.07
|
| Rate for Payer: BCN Commercial |
$382.54
|
| 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: Healthscope Commercial |
$445.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| Rate for Payer: PHP Commercial |
$420.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health HMO/PPO |
$430.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.60
|
| Rate for Payer: UHC Core |
$413.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.25
|
|
|
HC DEVICE NOT RETURNED RU SLEEPING
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 00614
|
| Hospital Charge Code |
27000614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna Medicare |
$252.50
|
| Rate for Payer: BCBS Complete |
$202.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.25
|
|
|
HC DEVICE NOT RETURNED RU SLEEPING
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 00614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna Medicare |
$252.50
|
| Rate for Payer: BCBS Complete |
$202.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.25
|
|
|
HC DEVICE NOT RETURNED WATCHPAT
|
Facility
|
OP
|
$4,950.00
|
|
| Hospital Charge Code |
27000604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,175.62 |
| Max. Negotiated Rate |
$4,455.00 |
| Rate for Payer: Aetna Commercial |
$4,207.50
|
| Rate for Payer: Aetna Medicare |
$1,287.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,546.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,546.88
|
| Rate for Payer: BCBS Complete |
$1,980.00
|
| Rate for Payer: BCBS MAPPO |
$1,237.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,069.40
|
| Rate for Payer: BCN Commercial |
$3,848.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,237.50
|
| Rate for Payer: Cash Price |
$3,960.00
|
| Rate for Payer: Cofinity Commercial |
$4,257.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,960.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,237.50
|
| Rate for Payer: Healthscope Commercial |
$4,455.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,712.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,299.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,423.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,207.50
|
| Rate for Payer: Nomi Health Commercial |
$4,059.00
|
| Rate for Payer: PACE Senior Care Partners |
$1,175.62
|
| Rate for Payer: PACE SWMI |
$1,237.50
|
| Rate for Payer: PHP Commercial |
$4,207.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,237.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,217.50
|
| Rate for Payer: Priority Health HMO/PPO |
$4,306.50
|
| Rate for Payer: Priority Health Medicare |
$1,249.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,316.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,237.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,356.00
|
| Rate for Payer: UHC Core |
$4,133.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,237.50
|
| Rate for Payer: UHC Exchange |
$1,237.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,237.50
|
| Rate for Payer: VA VA |
$1,237.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,712.50
|
|
|
HC DEVICE NOT RETURNED WATCHPAT
|
Professional
|
Both
|
$5,049.00
|
|
|
Service Code
|
HCPCS 00604
|
| Hospital Charge Code |
27000604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,019.60 |
| Max. Negotiated Rate |
$3,281.85 |
| Rate for Payer: Aetna Medicare |
$2,524.50
|
| Rate for Payer: BCBS Complete |
$2,019.60
|
| Rate for Payer: Cash Price |
$4,039.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,281.85
|
|
|
HC DEVICE NOT RETURNED WATCHPAT
|
Facility
|
IP
|
$4,950.00
|
|
| Hospital Charge Code |
27000604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,217.50 |
| Max. Negotiated Rate |
$4,455.00 |
| Rate for Payer: Aetna Commercial |
$4,207.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,040.68
|
| Rate for Payer: BCN Commercial |
$3,825.36
|
| Rate for Payer: Cash Price |
$3,960.00
|
| Rate for Payer: Cofinity Commercial |
$4,257.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,960.00
|
| Rate for Payer: Healthscope Commercial |
$4,455.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,712.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,207.50
|
| Rate for Payer: Nomi Health Commercial |
$4,059.00
|
| Rate for Payer: PHP Commercial |
$4,207.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,217.50
|
| Rate for Payer: Priority Health HMO/PPO |
$4,306.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,316.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,356.00
|
| Rate for Payer: UHC Core |
$4,133.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,712.50
|
|
|
HC DEVICE NOT RETURNED WATCHPAT
|
Professional
|
Both
|
$5,049.00
|
|
|
Service Code
|
HCPCS 00604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,019.60 |
| Max. Negotiated Rate |
$3,281.85 |
| Rate for Payer: Aetna Medicare |
$2,524.50
|
| Rate for Payer: BCBS Complete |
$2,019.60
|
| Rate for Payer: Cash Price |
$4,039.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,281.85
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
IP
|
$541.62
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$352.05 |
| Max. Negotiated Rate |
$487.46 |
| Rate for Payer: Aetna Commercial |
$460.38
|
| Rate for Payer: BCBS Trust/PPO |
$442.12
|
| Rate for Payer: BCN Commercial |
$418.56
|
| Rate for Payer: Cash Price |
$433.30
|
| Rate for Payer: Cofinity Commercial |
$465.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.30
|
| Rate for Payer: Healthscope Commercial |
$487.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.38
|
| Rate for Payer: Nomi Health Commercial |
$444.13
|
| Rate for Payer: PHP Commercial |
$460.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.05
|
| Rate for Payer: Priority Health HMO/PPO |
$471.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.63
|
| Rate for Payer: UHC Core |
$452.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.22
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
OP
|
$541.62
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$487.46 |
| Rate for Payer: Aetna Commercial |
$460.38
|
| Rate for Payer: Aetna Medicare |
$140.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.26
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS MAPPO |
$135.40
|
| Rate for Payer: BCBS Trust/PPO |
$445.27
|
| Rate for Payer: BCN Commercial |
$421.11
|
| Rate for Payer: BCN Medicare Advantage |
$135.40
|
| Rate for Payer: Cash Price |
$433.30
|
| Rate for Payer: Cash Price |
$433.30
|
| Rate for Payer: Cofinity Commercial |
$465.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.40
|
| Rate for Payer: Healthscope Commercial |
$487.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.22
|
| Rate for Payer: Mclaren Medicaid |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.18
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.38
|
| Rate for Payer: Nomi Health Commercial |
$444.13
|
| Rate for Payer: PACE Senior Care Partners |
$128.63
|
| Rate for Payer: PACE SWMI |
$135.40
|
| Rate for Payer: PHP Commercial |
$460.38
|
| Rate for Payer: PHP Medicare Advantage |
$135.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.05
|
| Rate for Payer: Priority Health HMO/PPO |
$471.21
|
| Rate for Payer: Priority Health Medicare |
$136.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.89
|
| Rate for Payer: Railroad Medicare Medicare |
$135.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.63
|
| Rate for Payer: UHC Core |
$452.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.40
|
| Rate for Payer: UHC Exchange |
$135.40
|
| Rate for Payer: UHC Medicare Advantage |
$135.40
|
| Rate for Payer: UHCCP Medicaid |
$75.33
|
| Rate for Payer: VA VA |
$135.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.22
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
IP
|
$204.23
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$183.81 |
| Rate for Payer: Aetna Commercial |
$173.60
|
| Rate for Payer: BCBS Trust/PPO |
$166.71
|
| Rate for Payer: BCN Commercial |
$157.83
|
| Rate for Payer: Cash Price |
$163.38
|
| Rate for Payer: Cofinity Commercial |
$175.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.38
|
| Rate for Payer: Healthscope Commercial |
$183.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.60
|
| Rate for Payer: Nomi Health Commercial |
$167.47
|
| Rate for Payer: PHP Commercial |
$173.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.75
|
| Rate for Payer: Priority Health HMO/PPO |
$177.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.72
|
| Rate for Payer: UHC Core |
$170.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.17
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
OP
|
$204.23
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$183.81 |
| Rate for Payer: Aetna Commercial |
$173.60
|
| Rate for Payer: Aetna Medicare |
$53.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.82
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$51.06
|
| Rate for Payer: BCBS Trust/PPO |
$167.90
|
| Rate for Payer: BCN Commercial |
$158.79
|
| Rate for Payer: BCN Medicare Advantage |
$51.06
|
| Rate for Payer: Cash Price |
$163.38
|
| Rate for Payer: Cash Price |
$163.38
|
| Rate for Payer: Cofinity Commercial |
$175.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.06
|
| Rate for Payer: Healthscope Commercial |
$183.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.17
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.61
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.60
|
| Rate for Payer: Nomi Health Commercial |
$167.47
|
| Rate for Payer: PACE Senior Care Partners |
$48.50
|
| Rate for Payer: PACE SWMI |
$51.06
|
| Rate for Payer: PHP Commercial |
$173.60
|
| Rate for Payer: PHP Medicare Advantage |
$51.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.75
|
| Rate for Payer: Priority Health HMO/PPO |
$177.68
|
| Rate for Payer: Priority Health Medicare |
$51.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.83
|
| Rate for Payer: Railroad Medicare Medicare |
$51.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.72
|
| Rate for Payer: UHC Core |
$170.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.06
|
| Rate for Payer: UHC Exchange |
$51.06
|
| Rate for Payer: UHC Medicare Advantage |
$51.06
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$51.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.17
|
|
