|
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 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
|
IP
|
$1,548.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,006.20 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Aetna Commercial |
$1,393.20
|
| Rate for Payer: ASR ASR |
$1,501.56
|
| Rate for Payer: ASR Commercial |
$1,501.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.47
|
| Rate for Payer: BCN Commercial |
$1,200.16
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,455.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Healthscope Commercial |
$1,548.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,501.56
|
| Rate for Payer: Mclaren Commercial |
$1,393.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,362.24
|
|
|
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 |
$619.20 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Aetna Commercial |
$1,393.20
|
| Rate for Payer: Aetna Medicare |
$774.00
|
| Rate for Payer: ASR ASR |
$1,501.56
|
| Rate for Payer: ASR Commercial |
$1,501.56
|
| Rate for Payer: BCBS Complete |
$619.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,267.66
|
| Rate for Payer: BCN Commercial |
$1,200.16
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,455.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Healthscope Commercial |
$1,548.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,501.56
|
| Rate for Payer: Mclaren Commercial |
$1,393.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,356.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,085.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,362.24
|
|
|
HC DEVICE NOT RETURNED CADD PUMP
|
Facility
|
OP
|
$3,723.00
|
|
| Hospital Charge Code |
27000642
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,489.20 |
| Max. Negotiated Rate |
$3,723.00 |
| Rate for Payer: Aetna Commercial |
$3,350.70
|
| Rate for Payer: Aetna Medicare |
$1,861.50
|
| Rate for Payer: ASR ASR |
$3,611.31
|
| Rate for Payer: ASR Commercial |
$3,611.31
|
| Rate for Payer: BCBS Complete |
$1,489.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,048.76
|
| Rate for Payer: BCN Commercial |
$2,886.44
|
| Rate for Payer: Cash Price |
$2,978.40
|
| Rate for Payer: Cofinity Commercial |
$3,499.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,978.40
|
| Rate for Payer: Healthscope Commercial |
$3,723.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,611.31
|
| Rate for Payer: Mclaren Commercial |
$3,350.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,164.55
|
| Rate for Payer: Nomi Health Commercial |
$3,052.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,419.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,262.09
|
| Rate for Payer: Priority Health Narrow Network |
$2,609.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,276.24
|
|
|
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 |
$3,723.00 |
| Rate for Payer: Aetna Commercial |
$3,350.70
|
| Rate for Payer: ASR ASR |
$3,611.31
|
| Rate for Payer: ASR Commercial |
$3,611.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,033.87
|
| Rate for Payer: BCN Commercial |
$2,886.44
|
| Rate for Payer: Cash Price |
$2,978.40
|
| Rate for Payer: Cofinity Commercial |
$3,499.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,978.40
|
| Rate for Payer: Healthscope Commercial |
$3,723.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,611.31
|
| Rate for Payer: Mclaren Commercial |
$3,350.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,164.55
|
| Rate for Payer: Nomi Health Commercial |
$3,052.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,419.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,276.24
|
|
|
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 |
$652.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: ASR ASR |
$632.44
|
| Rate for Payer: ASR Commercial |
$632.44
|
| Rate for Payer: BCBS Trust/PPO |
$531.31
|
| Rate for Payer: BCN Commercial |
$505.50
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cofinity Commercial |
$612.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.60
|
| Rate for Payer: Healthscope Commercial |
$652.00
|
| Rate for Payer: Healthscope Whirlpool |
$632.44
|
| Rate for Payer: Mclaren Commercial |
$586.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.20
|
| Rate for Payer: Nomi Health Commercial |
$534.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$573.76
|
|
|
HC DEVICE NOT RETURNED HOLTER MONITOR
|
Facility
|
OP
|
$652.00
|
|
| Hospital Charge Code |
27000705
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$260.80 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Medicare |
$326.00
|
| Rate for Payer: ASR ASR |
$632.44
|
| Rate for Payer: ASR Commercial |
$632.44
|
| Rate for Payer: BCBS Complete |
$260.80
|
| Rate for Payer: BCBS Trust/PPO |
$533.92
|
| Rate for Payer: BCN Commercial |
$505.50
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cofinity Commercial |
$612.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.60
|
| Rate for Payer: Healthscope Commercial |
$652.00
|
| Rate for Payer: Healthscope Whirlpool |
$632.44
|
| Rate for Payer: Mclaren Commercial |
$586.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.20
|
| Rate for Payer: Nomi Health Commercial |
$534.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$571.28
|
| Rate for Payer: Priority Health Narrow Network |
$457.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$573.76
|
|
|
HC DEVICE NOT RETURNED RU SLEEPING
|
Facility
|
OP
|
$495.00
|
|
| Hospital Charge Code |
27000614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$445.50
|
| Rate for Payer: Aetna Medicare |
$247.50
|
| Rate for Payer: ASR ASR |
$480.15
|
| Rate for Payer: ASR Commercial |
$480.15
|
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: BCBS Trust/PPO |
$405.36
|
| Rate for Payer: BCN Commercial |
$383.77
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$465.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$495.00
|
| Rate for Payer: Healthscope Whirlpool |
$480.15
|
| Rate for Payer: Mclaren Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.72
|
| Rate for Payer: Priority Health Narrow Network |
$347.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.60
|
|
|
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
|
Facility
|
IP
|
$495.00
|
|
| Hospital Charge Code |
27000614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$445.50
|
| Rate for Payer: ASR ASR |
$480.15
|
| Rate for Payer: ASR Commercial |
$480.15
|
| Rate for Payer: BCBS Trust/PPO |
$403.38
|
| Rate for Payer: BCN Commercial |
$383.77
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$465.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$495.00
|
| Rate for Payer: Healthscope Whirlpool |
$480.15
|
| Rate for Payer: Mclaren Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.60
|
|
|
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
|
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 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
|
OP
|
$4,950.00
|
|
| Hospital Charge Code |
27000604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,980.00 |
| Max. Negotiated Rate |
$4,950.00 |
| Rate for Payer: Aetna Commercial |
$4,455.00
|
| Rate for Payer: Aetna Medicare |
$2,475.00
|
| Rate for Payer: ASR ASR |
$4,801.50
|
| Rate for Payer: ASR Commercial |
$4,801.50
|
| Rate for Payer: BCBS Complete |
$1,980.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,053.55
|
| Rate for Payer: BCN Commercial |
$3,837.74
|
| Rate for Payer: Cash Price |
$3,960.00
|
| Rate for Payer: Cofinity Commercial |
$4,653.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,960.00
|
| Rate for Payer: Healthscope Commercial |
$4,950.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,801.50
|
| Rate for Payer: Mclaren Commercial |
$4,455.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,207.50
|
| Rate for Payer: Nomi Health Commercial |
$4,059.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,217.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,337.19
|
| Rate for Payer: Priority Health Narrow Network |
$3,469.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,356.00
|
|
|
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 |
$4,950.00 |
| Rate for Payer: Aetna Commercial |
$4,455.00
|
| Rate for Payer: ASR ASR |
$4,801.50
|
| Rate for Payer: ASR Commercial |
$4,801.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,033.76
|
| Rate for Payer: BCN Commercial |
$3,837.74
|
| Rate for Payer: Cash Price |
$3,960.00
|
| Rate for Payer: Cofinity Commercial |
$4,653.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,960.00
|
| Rate for Payer: Healthscope Commercial |
$4,950.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,801.50
|
| Rate for Payer: Mclaren Commercial |
$4,455.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,207.50
|
| Rate for Payer: Nomi Health Commercial |
$4,059.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,217.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,356.00
|
|
|
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 |
$541.62 |
| Rate for Payer: Aetna Commercial |
$487.46
|
| Rate for Payer: ASR ASR |
$525.37
|
| Rate for Payer: ASR Commercial |
$525.37
|
| Rate for Payer: BCBS Trust/PPO |
$441.37
|
| Rate for Payer: BCN Commercial |
$419.92
|
| Rate for Payer: Cash Price |
$433.30
|
| Rate for Payer: Cofinity Commercial |
$509.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.30
|
| Rate for Payer: Healthscope Commercial |
$541.62
|
| Rate for Payer: Healthscope Whirlpool |
$525.37
|
| Rate for Payer: Mclaren Commercial |
$487.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.38
|
| Rate for Payer: Nomi Health Commercial |
$444.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.63
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
OP
|
$541.62
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$541.62 |
| Rate for Payer: Aetna Commercial |
$487.46
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$525.37
|
| Rate for Payer: ASR Commercial |
$525.37
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$443.53
|
| Rate for Payer: BCN Commercial |
$419.92
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$433.30
|
| Rate for Payer: Cash Price |
$433.30
|
| Rate for Payer: Cofinity Commercial |
$509.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$541.62
|
| Rate for Payer: Healthscope Whirlpool |
$525.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$487.46
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.38
|
| Rate for Payer: Nomi Health Commercial |
$444.13
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.57
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$379.68
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
OP
|
$204.23
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$204.23 |
| Rate for Payer: Aetna Commercial |
$183.81
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$198.10
|
| Rate for Payer: ASR Commercial |
$198.10
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$167.24
|
| Rate for Payer: BCN Commercial |
$158.34
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$163.38
|
| Rate for Payer: Cash Price |
$163.38
|
| Rate for Payer: Cofinity Commercial |
$191.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$204.23
|
| Rate for Payer: Healthscope Whirlpool |
$198.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$183.81
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.60
|
| Rate for Payer: Nomi Health Commercial |
$167.47
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.95
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$143.17
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
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 |
$204.23 |
| Rate for Payer: Aetna Commercial |
$183.81
|
| Rate for Payer: ASR ASR |
$198.10
|
| Rate for Payer: ASR Commercial |
$198.10
|
| Rate for Payer: BCBS Trust/PPO |
$166.43
|
| Rate for Payer: BCN Commercial |
$158.34
|
| Rate for Payer: Cash Price |
$163.38
|
| Rate for Payer: Cofinity Commercial |
$191.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.38
|
| Rate for Payer: Healthscope Commercial |
$204.23
|
| Rate for Payer: Healthscope Whirlpool |
$198.10
|
| Rate for Payer: Mclaren Commercial |
$183.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.60
|
| Rate for Payer: Nomi Health Commercial |
$167.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.72
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
OP
|
$150.43
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$150.43 |
| Rate for Payer: Aetna Commercial |
$135.39
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$145.92
|
| Rate for Payer: ASR Commercial |
$145.92
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$123.19
|
| Rate for Payer: BCN Commercial |
$116.63
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$120.34
|
| Rate for Payer: Cash Price |
$120.34
|
| Rate for Payer: Cofinity Commercial |
$141.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$150.43
|
| Rate for Payer: Healthscope Whirlpool |
$145.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$135.39
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.87
|
| Rate for Payer: Nomi Health Commercial |
$123.35
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.81
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$105.45
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
IP
|
$150.43
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.78 |
| Max. Negotiated Rate |
$150.43 |
| Rate for Payer: Aetna Commercial |
$135.39
|
| Rate for Payer: ASR ASR |
$145.92
|
| Rate for Payer: ASR Commercial |
$145.92
|
| Rate for Payer: BCBS Trust/PPO |
$122.59
|
| Rate for Payer: BCN Commercial |
$116.63
|
| Rate for Payer: Cash Price |
$120.34
|
| Rate for Payer: Cofinity Commercial |
$141.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.34
|
| Rate for Payer: Healthscope Commercial |
$150.43
|
| Rate for Payer: Healthscope Whirlpool |
$145.92
|
| Rate for Payer: Mclaren Commercial |
$135.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.87
|
| Rate for Payer: Nomi Health Commercial |
$123.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.38
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: ASR Commercial |
$10.09
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS Trust/PPO |
$8.52
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.09
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.11
|
| Rate for Payer: Priority Health Narrow Network |
$7.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: ASR Commercial |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.47
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.09
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
