|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
OP
|
$1,291.12
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,162.01 |
| Rate for Payer: Aetna Commercial |
$1,097.45
|
| Rate for Payer: Aetna Medicare |
$335.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$403.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$403.48
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$322.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,003.85
|
| Rate for Payer: BCN Commercial |
$1,003.85
|
| Rate for Payer: BCN Medicare Advantage |
$322.78
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cofinity Commercial |
$1,110.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.78
|
| Rate for Payer: Healthscope Commercial |
$1,162.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$968.34
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$338.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$371.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,097.45
|
| Rate for Payer: PACE Senior Care Partners |
$306.64
|
| Rate for Payer: PACE SWMI |
$322.78
|
| Rate for Payer: PHP Commercial |
$1,097.45
|
| Rate for Payer: PHP Medicare Advantage |
$322.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$903.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,123.27
|
| Rate for Payer: Priority Health Medicare |
$322.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$787.45
|
| Rate for Payer: Railroad Medicare Medicare |
$322.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,136.19
|
| Rate for Payer: UHC Core |
$1,078.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.78
|
| Rate for Payer: UHC Medicare Advantage |
$332.46
|
| Rate for Payer: VA VA |
$322.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$968.34
|
|
|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
IP
|
$1,291.12
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$787.45 |
| Max. Negotiated Rate |
$1,162.01 |
| Rate for Payer: Aetna Commercial |
$1,097.45
|
| Rate for Payer: BCBS Trust/PPO |
$997.78
|
| Rate for Payer: BCN Commercial |
$997.78
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cofinity Commercial |
$1,110.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.90
|
| Rate for Payer: Healthscope Commercial |
$1,162.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$968.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,097.45
|
| Rate for Payer: PHP Commercial |
$1,097.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$903.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,123.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$787.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,136.19
|
| Rate for Payer: UHC Core |
$1,078.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$968.34
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
OP
|
$2,114.15
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,902.74 |
| Rate for Payer: Aetna Commercial |
$1,797.03
|
| Rate for Payer: Aetna Medicare |
$549.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$660.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$660.67
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$528.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.75
|
| Rate for Payer: BCN Commercial |
$1,643.75
|
| Rate for Payer: BCN Medicare Advantage |
$528.54
|
| Rate for Payer: Cash Price |
$1,691.32
|
| Rate for Payer: Cash Price |
$1,691.32
|
| Rate for Payer: Cofinity Commercial |
$1,818.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.54
|
| Rate for Payer: Healthscope Commercial |
$1,902.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,585.61
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$554.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$607.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.03
|
| Rate for Payer: PACE Senior Care Partners |
$502.11
|
| Rate for Payer: PACE SWMI |
$528.54
|
| Rate for Payer: PHP Commercial |
$1,797.03
|
| Rate for Payer: PHP Medicare Advantage |
$528.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,839.31
|
| Rate for Payer: Priority Health Medicare |
$528.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,289.42
|
| Rate for Payer: Railroad Medicare Medicare |
$528.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,860.45
|
| Rate for Payer: UHC Core |
$1,765.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.54
|
| Rate for Payer: UHC Medicare Advantage |
$544.39
|
| Rate for Payer: VA VA |
$528.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.61
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
IP
|
$2,114.15
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,289.42 |
| Max. Negotiated Rate |
$1,902.74 |
| Rate for Payer: Aetna Commercial |
$1,797.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,633.82
|
| Rate for Payer: BCN Commercial |
$1,633.82
|
| Rate for Payer: Cash Price |
$1,691.32
|
| Rate for Payer: Cofinity Commercial |
$1,818.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.32
|
| Rate for Payer: Healthscope Commercial |
$1,902.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,585.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.03
|
| Rate for Payer: PHP Commercial |
$1,797.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,839.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,289.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,860.45
|
| Rate for Payer: UHC Core |
$1,765.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.61
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
IP
|
$678.15
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$413.60 |
| Max. Negotiated Rate |
$610.34 |
| Rate for Payer: Aetna Commercial |
$576.43
|
| Rate for Payer: BCBS Trust/PPO |
$524.07
|
| Rate for Payer: BCN Commercial |
$524.07
|
| Rate for Payer: Cash Price |
$542.52
|
| Rate for Payer: Cofinity Commercial |
$583.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.52
|
| Rate for Payer: Healthscope Commercial |
$610.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$508.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.43
|
| Rate for Payer: PHP Commercial |
$576.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$589.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$596.77
|
| Rate for Payer: UHC Core |
$566.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$508.61
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
OP
|
$678.15
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$610.34 |
| Rate for Payer: Aetna Commercial |
$576.43
|
| Rate for Payer: Aetna Medicare |
$176.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.92
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$169.54
|
| Rate for Payer: BCBS Trust/PPO |
$527.26
|
| Rate for Payer: BCN Commercial |
$527.26
|
| Rate for Payer: BCN Medicare Advantage |
$169.54
|
| Rate for Payer: Cash Price |
$542.52
|
| Rate for Payer: Cash Price |
$542.52
|
| Rate for Payer: Cofinity Commercial |
$583.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.54
|
| Rate for Payer: Healthscope Commercial |
$610.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$508.61
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$178.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.43
|
| Rate for Payer: PACE Senior Care Partners |
$161.06
|
| Rate for Payer: PACE SWMI |
$169.54
|
| Rate for Payer: PHP Commercial |
$576.43
|
| Rate for Payer: PHP Medicare Advantage |
$169.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$589.99
|
| Rate for Payer: Priority Health Medicare |
$169.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.60
|
| Rate for Payer: Railroad Medicare Medicare |
$169.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$596.77
|
| Rate for Payer: UHC Core |
$566.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.54
|
| Rate for Payer: UHC Medicare Advantage |
$174.62
|
| Rate for Payer: VA VA |
$169.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$508.61
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
IP
|
$1,031.42
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$629.06 |
| Max. Negotiated Rate |
$928.28 |
| Rate for Payer: Aetna Commercial |
$876.71
|
| Rate for Payer: BCBS Trust/PPO |
$797.08
|
| Rate for Payer: BCN Commercial |
$797.08
|
| Rate for Payer: Cash Price |
$825.14
|
| Rate for Payer: Cofinity Commercial |
$887.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.14
|
| Rate for Payer: Healthscope Commercial |
$928.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.71
|
| Rate for Payer: PHP Commercial |
$876.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$629.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$907.65
|
| Rate for Payer: UHC Core |
$861.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.56
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
OP
|
$1,031.42
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$244.96 |
| Max. Negotiated Rate |
$928.28 |
| Rate for Payer: Aetna Commercial |
$876.71
|
| Rate for Payer: Aetna Medicare |
$268.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$322.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$322.32
|
| Rate for Payer: BCBS Complete |
$412.57
|
| Rate for Payer: BCBS MAPPO |
$257.86
|
| Rate for Payer: BCBS Trust/PPO |
$801.93
|
| Rate for Payer: BCN Commercial |
$801.93
|
| Rate for Payer: BCN Medicare Advantage |
$257.86
|
| Rate for Payer: Cash Price |
$825.14
|
| Rate for Payer: Cofinity Commercial |
$887.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.86
|
| Rate for Payer: Healthscope Commercial |
$928.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.71
|
| Rate for Payer: PACE Senior Care Partners |
$244.96
|
| Rate for Payer: PACE SWMI |
$257.86
|
| Rate for Payer: PHP Commercial |
$876.71
|
| Rate for Payer: PHP Medicare Advantage |
$257.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.34
|
| Rate for Payer: Priority Health Medicare |
$257.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$629.06
|
| Rate for Payer: Railroad Medicare Medicare |
$257.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$907.65
|
| Rate for Payer: UHC Core |
$861.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.86
|
| Rate for Payer: UHC Medicare Advantage |
$265.59
|
| Rate for Payer: VA VA |
$257.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.56
|
|
|
HC CT BRAIN W CON
|
Facility
|
OP
|
$1,590.89
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,431.80 |
| Rate for Payer: Aetna Commercial |
$1,352.26
|
| Rate for Payer: Aetna Medicare |
$413.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.15
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$397.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.92
|
| Rate for Payer: BCN Commercial |
$1,236.92
|
| Rate for Payer: BCN Medicare Advantage |
$397.72
|
| Rate for Payer: Cash Price |
$1,272.71
|
| Rate for Payer: Cash Price |
$1,272.71
|
| Rate for Payer: Cofinity Commercial |
$1,368.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.72
|
| Rate for Payer: Healthscope Commercial |
$1,431.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,193.17
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$417.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$457.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,352.26
|
| Rate for Payer: PACE Senior Care Partners |
$377.84
|
| Rate for Payer: PACE SWMI |
$397.72
|
| Rate for Payer: PHP Commercial |
$1,352.26
|
| Rate for Payer: PHP Medicare Advantage |
$397.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,384.07
|
| Rate for Payer: Priority Health Medicare |
$397.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.28
|
| Rate for Payer: Railroad Medicare Medicare |
$397.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,399.98
|
| Rate for Payer: UHC Core |
$1,328.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$397.72
|
| Rate for Payer: UHC Medicare Advantage |
$409.65
|
| Rate for Payer: VA VA |
$397.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,193.17
|
|
|
HC CT BRAIN W CON
|
Facility
|
IP
|
$1,590.89
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,431.80 |
| Rate for Payer: Aetna Commercial |
$1,352.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,229.44
|
| Rate for Payer: BCN Commercial |
$1,229.44
|
| Rate for Payer: Cash Price |
$1,272.71
|
| Rate for Payer: Cofinity Commercial |
$1,368.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.71
|
| Rate for Payer: Healthscope Commercial |
$1,431.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,193.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,352.26
|
| Rate for Payer: PHP Commercial |
$1,352.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,384.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,399.98
|
| Rate for Payer: UHC Core |
$1,328.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,193.17
|
|
|
HC CT BRAIN WO CON
|
Facility
|
OP
|
$1,484.45
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna Commercial |
$1,261.78
|
| Rate for Payer: Aetna Medicare |
$385.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$463.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$463.89
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$371.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,154.16
|
| Rate for Payer: BCN Commercial |
$1,154.16
|
| Rate for Payer: BCN Medicare Advantage |
$371.11
|
| Rate for Payer: Cash Price |
$1,187.56
|
| Rate for Payer: Cash Price |
$1,187.56
|
| Rate for Payer: Cofinity Commercial |
$1,276.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.11
|
| Rate for Payer: Healthscope Commercial |
$1,336.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.34
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$389.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,261.78
|
| Rate for Payer: PACE Senior Care Partners |
$352.56
|
| Rate for Payer: PACE SWMI |
$371.11
|
| Rate for Payer: PHP Commercial |
$1,261.78
|
| Rate for Payer: PHP Medicare Advantage |
$371.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,291.47
|
| Rate for Payer: Priority Health Medicare |
$371.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$905.37
|
| Rate for Payer: Railroad Medicare Medicare |
$371.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.32
|
| Rate for Payer: UHC Core |
$1,239.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.11
|
| Rate for Payer: UHC Medicare Advantage |
$382.25
|
| Rate for Payer: VA VA |
$371.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.34
|
|
|
HC CT BRAIN WO CON
|
Facility
|
IP
|
$1,484.45
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$905.37 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna Commercial |
$1,261.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,147.18
|
| Rate for Payer: BCN Commercial |
$1,147.18
|
| Rate for Payer: Cash Price |
$1,187.56
|
| Rate for Payer: Cofinity Commercial |
$1,276.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.56
|
| Rate for Payer: Healthscope Commercial |
$1,336.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,261.78
|
| Rate for Payer: PHP Commercial |
$1,261.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,291.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$905.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.32
|
| Rate for Payer: UHC Core |
$1,239.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.34
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
IP
|
$1,790.10
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,091.78 |
| Max. Negotiated Rate |
$1,611.09 |
| Rate for Payer: Aetna Commercial |
$1,521.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,383.39
|
| Rate for Payer: BCN Commercial |
$1,383.39
|
| Rate for Payer: Cash Price |
$1,432.08
|
| Rate for Payer: Cofinity Commercial |
$1,539.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,432.08
|
| Rate for Payer: Healthscope Commercial |
$1,611.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,342.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,521.58
|
| Rate for Payer: PHP Commercial |
$1,521.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,557.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,091.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,575.29
|
| Rate for Payer: UHC Core |
$1,494.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,342.58
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
OP
|
$1,790.10
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,611.09 |
| Rate for Payer: Aetna Commercial |
$1,521.58
|
| Rate for Payer: Aetna Medicare |
$465.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$559.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$559.41
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$447.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,391.80
|
| Rate for Payer: BCN Commercial |
$1,391.80
|
| Rate for Payer: BCN Medicare Advantage |
$447.52
|
| Rate for Payer: Cash Price |
$1,432.08
|
| Rate for Payer: Cash Price |
$1,432.08
|
| Rate for Payer: Cofinity Commercial |
$1,539.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,432.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.52
|
| Rate for Payer: Healthscope Commercial |
$1,611.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,342.58
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$469.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,521.58
|
| Rate for Payer: PACE Senior Care Partners |
$425.15
|
| Rate for Payer: PACE SWMI |
$447.52
|
| Rate for Payer: PHP Commercial |
$1,521.58
|
| Rate for Payer: PHP Medicare Advantage |
$447.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,557.39
|
| Rate for Payer: Priority Health Medicare |
$447.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,091.78
|
| Rate for Payer: Railroad Medicare Medicare |
$447.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,575.29
|
| Rate for Payer: UHC Core |
$1,494.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$447.52
|
| Rate for Payer: UHC Medicare Advantage |
$460.95
|
| Rate for Payer: VA VA |
$447.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,342.58
|
|
|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
IP
|
$2,027.45
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,236.54 |
| Max. Negotiated Rate |
$1,824.70 |
| Rate for Payer: Aetna Commercial |
$1,723.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,566.81
|
| Rate for Payer: BCN Commercial |
$1,566.81
|
| Rate for Payer: Cash Price |
$1,621.96
|
| Rate for Payer: Cofinity Commercial |
$1,743.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,621.96
|
| Rate for Payer: Healthscope Commercial |
$1,824.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,520.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,723.33
|
| Rate for Payer: PHP Commercial |
$1,723.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,419.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,763.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,236.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,784.16
|
| Rate for Payer: UHC Core |
$1,692.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,520.59
|
|
|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
OP
|
$2,027.45
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,824.70 |
| Rate for Payer: Aetna Commercial |
$1,723.33
|
| Rate for Payer: Aetna Medicare |
$527.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$633.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$633.58
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$506.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,576.34
|
| Rate for Payer: BCN Commercial |
$1,576.34
|
| Rate for Payer: BCN Medicare Advantage |
$506.86
|
| Rate for Payer: Cash Price |
$1,621.96
|
| Rate for Payer: Cash Price |
$1,621.96
|
| Rate for Payer: Cofinity Commercial |
$1,743.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,621.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$506.86
|
| Rate for Payer: Healthscope Commercial |
$1,824.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,520.59
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$532.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$582.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,723.33
|
| Rate for Payer: PACE Senior Care Partners |
$481.52
|
| Rate for Payer: PACE SWMI |
$506.86
|
| Rate for Payer: PHP Commercial |
$1,723.33
|
| Rate for Payer: PHP Medicare Advantage |
$506.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,419.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,763.88
|
| Rate for Payer: Priority Health Medicare |
$506.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,236.54
|
| Rate for Payer: Railroad Medicare Medicare |
$506.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,784.16
|
| Rate for Payer: UHC Core |
$1,692.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$506.86
|
| Rate for Payer: UHC Medicare Advantage |
$522.07
|
| Rate for Payer: VA VA |
$506.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,520.59
|
|
|
HC CT CHEST SCREENING LUNG CANCER
|
Facility
|
IP
|
$505.03
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$308.02 |
| Max. Negotiated Rate |
$454.53 |
| Rate for Payer: Aetna Commercial |
$429.28
|
| Rate for Payer: BCBS Trust/PPO |
$390.29
|
| Rate for Payer: BCN Commercial |
$390.29
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cofinity Commercial |
$434.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.02
|
| Rate for Payer: Healthscope Commercial |
$454.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$429.28
|
| Rate for Payer: PHP Commercial |
$429.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.43
|
| Rate for Payer: UHC Core |
$421.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.77
|
|
|
HC CT CHEST SCREENING LUNG CANCER
|
Facility
|
OP
|
$505.03
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$454.53 |
| Rate for Payer: Aetna Commercial |
$429.28
|
| Rate for Payer: Aetna Medicare |
$131.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.82
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$126.26
|
| Rate for Payer: BCBS Trust/PPO |
$392.66
|
| Rate for Payer: BCN Commercial |
$392.66
|
| Rate for Payer: BCN Medicare Advantage |
$126.26
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cofinity Commercial |
$434.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$454.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.77
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$132.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$429.28
|
| Rate for Payer: PACE Senior Care Partners |
$119.94
|
| Rate for Payer: PACE SWMI |
$126.26
|
| Rate for Payer: PHP Commercial |
$429.28
|
| Rate for Payer: PHP Medicare Advantage |
$126.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.38
|
| Rate for Payer: Priority Health Medicare |
$126.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.02
|
| Rate for Payer: Railroad Medicare Medicare |
$126.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.43
|
| Rate for Payer: UHC Core |
$421.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.26
|
| Rate for Payer: UHC Medicare Advantage |
$130.05
|
| Rate for Payer: VA VA |
$126.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.77
|
|
|
HC CT CHEST WITH CON
|
Facility
|
OP
|
$1,703.09
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,532.78 |
| Rate for Payer: Aetna Commercial |
$1,447.63
|
| Rate for Payer: Aetna Medicare |
$442.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$532.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$532.22
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$425.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.15
|
| Rate for Payer: BCN Commercial |
$1,324.15
|
| Rate for Payer: BCN Medicare Advantage |
$425.77
|
| Rate for Payer: Cash Price |
$1,362.47
|
| Rate for Payer: Cash Price |
$1,362.47
|
| Rate for Payer: Cofinity Commercial |
$1,464.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,362.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.77
|
| Rate for Payer: Healthscope Commercial |
$1,532.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,277.32
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$447.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$489.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,447.63
|
| Rate for Payer: PACE Senior Care Partners |
$404.48
|
| Rate for Payer: PACE SWMI |
$425.77
|
| Rate for Payer: PHP Commercial |
$1,447.63
|
| Rate for Payer: PHP Medicare Advantage |
$425.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,481.69
|
| Rate for Payer: Priority Health Medicare |
$425.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,038.71
|
| Rate for Payer: Railroad Medicare Medicare |
$425.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,498.72
|
| Rate for Payer: UHC Core |
$1,422.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$425.77
|
| Rate for Payer: UHC Medicare Advantage |
$438.55
|
| Rate for Payer: VA VA |
$425.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,277.32
|
|
|
HC CT CHEST WITH CON
|
Facility
|
IP
|
$1,703.09
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,038.71 |
| Max. Negotiated Rate |
$1,532.78 |
| Rate for Payer: Aetna Commercial |
$1,447.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.15
|
| Rate for Payer: BCN Commercial |
$1,316.15
|
| Rate for Payer: Cash Price |
$1,362.47
|
| Rate for Payer: Cofinity Commercial |
$1,464.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,362.47
|
| Rate for Payer: Healthscope Commercial |
$1,532.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,277.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,447.63
|
| Rate for Payer: PHP Commercial |
$1,447.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,481.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,038.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,498.72
|
| Rate for Payer: UHC Core |
$1,422.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,277.32
|
|
|
HC CT CHEST WO CON
|
Facility
|
OP
|
$1,484.40
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$1,335.96 |
| Rate for Payer: Aetna Commercial |
$1,261.74
|
| Rate for Payer: Aetna Medicare |
$385.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$463.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$463.88
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$371.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,154.12
|
| Rate for Payer: BCN Commercial |
$1,154.12
|
| Rate for Payer: BCN Medicare Advantage |
$371.10
|
| Rate for Payer: Cash Price |
$1,187.52
|
| Rate for Payer: Cash Price |
$1,187.52
|
| Rate for Payer: Cofinity Commercial |
$1,276.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.10
|
| Rate for Payer: Healthscope Commercial |
$1,335.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.30
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$389.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,261.74
|
| Rate for Payer: PACE Senior Care Partners |
$352.54
|
| Rate for Payer: PACE SWMI |
$371.10
|
| Rate for Payer: PHP Commercial |
$1,261.74
|
| Rate for Payer: PHP Medicare Advantage |
$371.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,291.43
|
| Rate for Payer: Priority Health Medicare |
$371.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$905.34
|
| Rate for Payer: Railroad Medicare Medicare |
$371.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.27
|
| Rate for Payer: UHC Core |
$1,239.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.10
|
| Rate for Payer: UHC Medicare Advantage |
$382.23
|
| Rate for Payer: VA VA |
$371.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.30
|
|
|
HC CT CHEST WO CON
|
Facility
|
IP
|
$1,484.40
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$905.34 |
| Max. Negotiated Rate |
$1,335.96 |
| Rate for Payer: Aetna Commercial |
$1,261.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,147.14
|
| Rate for Payer: BCN Commercial |
$1,147.14
|
| Rate for Payer: Cash Price |
$1,187.52
|
| Rate for Payer: Cofinity Commercial |
$1,276.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.52
|
| Rate for Payer: Healthscope Commercial |
$1,335.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,261.74
|
| Rate for Payer: PHP Commercial |
$1,261.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,291.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$905.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.27
|
| Rate for Payer: UHC Core |
$1,239.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.30
|
|
|
HC CT CHEST WO W CON
|
Facility
|
OP
|
$2,015.62
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
35200002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,814.06 |
| Rate for Payer: Aetna Commercial |
$1,713.28
|
| Rate for Payer: Aetna Medicare |
$524.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$629.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$629.88
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$503.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,567.14
|
| Rate for Payer: BCN Commercial |
$1,567.14
|
| Rate for Payer: BCN Medicare Advantage |
$503.90
|
| Rate for Payer: Cash Price |
$1,612.50
|
| Rate for Payer: Cash Price |
$1,612.50
|
| Rate for Payer: Cofinity Commercial |
$1,733.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$503.90
|
| Rate for Payer: Healthscope Commercial |
$1,814.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,511.72
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$529.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$579.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,713.28
|
| Rate for Payer: PACE Senior Care Partners |
$478.71
|
| Rate for Payer: PACE SWMI |
$503.90
|
| Rate for Payer: PHP Commercial |
$1,713.28
|
| Rate for Payer: PHP Medicare Advantage |
$503.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,753.59
|
| Rate for Payer: Priority Health Medicare |
$503.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,229.33
|
| Rate for Payer: Railroad Medicare Medicare |
$503.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,773.75
|
| Rate for Payer: UHC Core |
$1,683.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$503.90
|
| Rate for Payer: UHC Medicare Advantage |
$519.02
|
| Rate for Payer: VA VA |
$503.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,511.72
|
|
|
HC CT CHEST WO W CON
|
Facility
|
IP
|
$2,015.62
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
35200002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,229.33 |
| Max. Negotiated Rate |
$1,814.06 |
| Rate for Payer: Aetna Commercial |
$1,713.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,557.67
|
| Rate for Payer: BCN Commercial |
$1,557.67
|
| Rate for Payer: Cash Price |
$1,612.50
|
| Rate for Payer: Cofinity Commercial |
$1,733.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.50
|
| Rate for Payer: Healthscope Commercial |
$1,814.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,511.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,713.28
|
| Rate for Payer: PHP Commercial |
$1,713.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,753.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,229.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,773.75
|
| Rate for Payer: UHC Core |
$1,683.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,511.72
|
|
|
HC CT CORONARY ANGIO
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Medicare |
$351.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.92
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$338.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,052.22
|
| Rate for Payer: BCN Commercial |
$1,052.22
|
| Rate for Payer: BCN Medicare Advantage |
$338.34
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.34
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.00
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$355.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$389.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.34
|
| Rate for Payer: PACE Senior Care Partners |
$321.42
|
| Rate for Payer: PACE SWMI |
$338.34
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: PHP Medicare Advantage |
$338.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,177.41
|
| Rate for Payer: Priority Health Medicare |
$338.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$825.40
|
| Rate for Payer: Railroad Medicare Medicare |
$338.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.94
|
| Rate for Payer: UHC Core |
$1,130.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.34
|
| Rate for Payer: UHC Medicare Advantage |
$348.49
|
| Rate for Payer: VA VA |
$338.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.00
|
|
