|
HC CT CORONARY ANGIO
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$825.40 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,045.86
|
| Rate for Payer: BCN Commercial |
$1,045.86
|
| 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: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.34
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| 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 Narrow/Tiered Network |
$825.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.94
|
| Rate for Payer: UHC Core |
$1,130.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.00
|
|
|
HC CT CRYOABLATION GUIDANCE
|
Facility
|
IP
|
$1,075.08
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$655.69 |
| Max. Negotiated Rate |
$967.57 |
| Rate for Payer: Aetna Commercial |
$913.82
|
| Rate for Payer: BCBS Trust/PPO |
$830.82
|
| Rate for Payer: BCN Commercial |
$830.82
|
| Rate for Payer: Cash Price |
$860.06
|
| Rate for Payer: Cofinity Commercial |
$924.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$860.06
|
| Rate for Payer: Healthscope Commercial |
$967.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$806.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$913.82
|
| Rate for Payer: PHP Commercial |
$913.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$655.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$946.07
|
| Rate for Payer: UHC Core |
$897.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$806.31
|
|
|
HC CT CRYOABLATION GUIDANCE
|
Facility
|
OP
|
$1,075.08
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$255.33 |
| Max. Negotiated Rate |
$967.57 |
| Rate for Payer: Aetna Commercial |
$913.82
|
| Rate for Payer: Aetna Medicare |
$279.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$335.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$335.96
|
| Rate for Payer: BCBS Complete |
$430.03
|
| Rate for Payer: BCBS MAPPO |
$268.77
|
| Rate for Payer: BCBS Trust/PPO |
$835.87
|
| Rate for Payer: BCN Commercial |
$835.87
|
| Rate for Payer: BCN Medicare Advantage |
$268.77
|
| Rate for Payer: Cash Price |
$860.06
|
| Rate for Payer: Cofinity Commercial |
$924.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$860.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.77
|
| Rate for Payer: Healthscope Commercial |
$967.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$806.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$282.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$913.82
|
| Rate for Payer: PACE Senior Care Partners |
$255.33
|
| Rate for Payer: PACE SWMI |
$268.77
|
| Rate for Payer: PHP Commercial |
$913.82
|
| Rate for Payer: PHP Medicare Advantage |
$268.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.32
|
| Rate for Payer: Priority Health Medicare |
$268.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$655.69
|
| Rate for Payer: Railroad Medicare Medicare |
$268.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$946.07
|
| Rate for Payer: UHC Core |
$897.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$268.77
|
| Rate for Payer: UHC Medicare Advantage |
$276.83
|
| Rate for Payer: VA VA |
$268.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$806.31
|
|
|
HC CT FACIAL W CON
|
Facility
|
OP
|
$1,560.50
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
35100008
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,404.45 |
| Rate for Payer: Aetna Commercial |
$1,326.42
|
| Rate for Payer: Aetna Medicare |
$405.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.66
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$390.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,213.29
|
| Rate for Payer: BCN Commercial |
$1,213.29
|
| Rate for Payer: BCN Medicare Advantage |
$390.12
|
| Rate for Payer: Cash Price |
$1,248.40
|
| Rate for Payer: Cash Price |
$1,248.40
|
| Rate for Payer: Cofinity Commercial |
$1,342.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,248.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.12
|
| Rate for Payer: Healthscope Commercial |
$1,404.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,170.38
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$409.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,326.42
|
| Rate for Payer: PACE Senior Care Partners |
$370.62
|
| Rate for Payer: PACE SWMI |
$390.12
|
| Rate for Payer: PHP Commercial |
$1,326.42
|
| Rate for Payer: PHP Medicare Advantage |
$390.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,357.64
|
| Rate for Payer: Priority Health Medicare |
$390.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$951.75
|
| Rate for Payer: Railroad Medicare Medicare |
$390.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,373.24
|
| Rate for Payer: UHC Core |
$1,303.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.12
|
| Rate for Payer: UHC Medicare Advantage |
$401.83
|
| Rate for Payer: VA VA |
$390.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,170.38
|
|
|
HC CT FACIAL W CON
|
Facility
|
IP
|
$1,560.50
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
35100008
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$951.75 |
| Max. Negotiated Rate |
$1,404.45 |
| Rate for Payer: Aetna Commercial |
$1,326.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,205.95
|
| Rate for Payer: BCN Commercial |
$1,205.95
|
| Rate for Payer: Cash Price |
$1,248.40
|
| Rate for Payer: Cofinity Commercial |
$1,342.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,248.40
|
| Rate for Payer: Healthscope Commercial |
$1,404.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,170.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,326.42
|
| Rate for Payer: PHP Commercial |
$1,326.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,357.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$951.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,373.24
|
| Rate for Payer: UHC Core |
$1,303.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,170.38
|
|
|
HC CT FACIAL WO CON
|
Facility
|
OP
|
$1,383.22
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
35100007
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$1,244.90 |
| Rate for Payer: Aetna Commercial |
$1,175.74
|
| Rate for Payer: Aetna Medicare |
$359.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$432.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$432.26
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$345.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,075.45
|
| Rate for Payer: BCN Commercial |
$1,075.45
|
| Rate for Payer: BCN Medicare Advantage |
$345.80
|
| Rate for Payer: Cash Price |
$1,106.58
|
| Rate for Payer: Cash Price |
$1,106.58
|
| Rate for Payer: Cofinity Commercial |
$1,189.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,106.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.80
|
| Rate for Payer: Healthscope Commercial |
$1,244.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,037.42
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$363.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$397.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,175.74
|
| Rate for Payer: PACE Senior Care Partners |
$328.51
|
| Rate for Payer: PACE SWMI |
$345.80
|
| Rate for Payer: PHP Commercial |
$1,175.74
|
| Rate for Payer: PHP Medicare Advantage |
$345.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$968.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,203.40
|
| Rate for Payer: Priority Health Medicare |
$345.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$843.63
|
| Rate for Payer: Railroad Medicare Medicare |
$345.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,217.23
|
| Rate for Payer: UHC Core |
$1,154.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.80
|
| Rate for Payer: UHC Medicare Advantage |
$356.18
|
| Rate for Payer: VA VA |
$345.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,037.42
|
|
|
HC CT FACIAL WO CON
|
Facility
|
IP
|
$1,383.22
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
35100007
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$843.63 |
| Max. Negotiated Rate |
$1,244.90 |
| Rate for Payer: Aetna Commercial |
$1,175.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,068.95
|
| Rate for Payer: BCN Commercial |
$1,068.95
|
| Rate for Payer: Cash Price |
$1,106.58
|
| Rate for Payer: Cofinity Commercial |
$1,189.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,106.58
|
| Rate for Payer: Healthscope Commercial |
$1,244.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,037.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,175.74
|
| Rate for Payer: PHP Commercial |
$1,175.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$968.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,203.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$843.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,217.23
|
| Rate for Payer: UHC Core |
$1,154.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,037.42
|
|
|
HC CT FACIAL WO W CON
|
Facility
|
IP
|
$1,469.30
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
35101009
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$896.13 |
| Max. Negotiated Rate |
$1,322.37 |
| Rate for Payer: Aetna Commercial |
$1,248.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,135.48
|
| Rate for Payer: BCN Commercial |
$1,135.48
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cofinity Commercial |
$1,263.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.44
|
| Rate for Payer: Healthscope Commercial |
$1,322.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,101.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,248.90
|
| Rate for Payer: PHP Commercial |
$1,248.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,278.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$896.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,292.98
|
| Rate for Payer: UHC Core |
$1,226.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,101.98
|
|
|
HC CT FACIAL WO W CON
|
Facility
|
OP
|
$1,469.30
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
35101009
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,322.37 |
| Rate for Payer: Aetna Commercial |
$1,248.90
|
| Rate for Payer: Aetna Medicare |
$382.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$459.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$459.16
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$367.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,142.38
|
| Rate for Payer: BCN Commercial |
$1,142.38
|
| Rate for Payer: BCN Medicare Advantage |
$367.32
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cofinity Commercial |
$1,263.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$367.32
|
| Rate for Payer: Healthscope Commercial |
$1,322.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,101.98
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,248.90
|
| Rate for Payer: PACE Senior Care Partners |
$348.96
|
| Rate for Payer: PACE SWMI |
$367.32
|
| Rate for Payer: PHP Commercial |
$1,248.90
|
| Rate for Payer: PHP Medicare Advantage |
$367.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,278.29
|
| Rate for Payer: Priority Health Medicare |
$367.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$896.13
|
| Rate for Payer: Railroad Medicare Medicare |
$367.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,292.98
|
| Rate for Payer: UHC Core |
$1,226.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$367.32
|
| Rate for Payer: UHC Medicare Advantage |
$378.34
|
| Rate for Payer: VA VA |
$367.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,101.98
|
|
|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
OP
|
$1,420.15
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$337.29 |
| Max. Negotiated Rate |
$1,278.14 |
| Rate for Payer: Aetna Commercial |
$1,207.13
|
| Rate for Payer: Aetna Medicare |
$369.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.80
|
| Rate for Payer: BCBS Complete |
$568.06
|
| Rate for Payer: BCBS MAPPO |
$355.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.17
|
| Rate for Payer: BCN Commercial |
$1,104.17
|
| Rate for Payer: BCN Medicare Advantage |
$355.04
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cofinity Commercial |
$1,221.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.04
|
| Rate for Payer: Healthscope Commercial |
$1,278.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.13
|
| Rate for Payer: PACE Senior Care Partners |
$337.29
|
| Rate for Payer: PACE SWMI |
$355.04
|
| Rate for Payer: PHP Commercial |
$1,207.13
|
| Rate for Payer: PHP Medicare Advantage |
$355.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,235.53
|
| Rate for Payer: Priority Health Medicare |
$355.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$866.15
|
| Rate for Payer: Railroad Medicare Medicare |
$355.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,249.73
|
| Rate for Payer: UHC Core |
$1,185.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.04
|
| Rate for Payer: UHC Medicare Advantage |
$365.69
|
| Rate for Payer: VA VA |
$355.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.11
|
|
|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
IP
|
$1,420.15
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$866.15 |
| Max. Negotiated Rate |
$1,278.14 |
| Rate for Payer: Aetna Commercial |
$1,207.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,097.49
|
| Rate for Payer: BCN Commercial |
$1,097.49
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cofinity Commercial |
$1,221.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.12
|
| Rate for Payer: Healthscope Commercial |
$1,278.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.13
|
| Rate for Payer: PHP Commercial |
$1,207.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,235.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$866.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,249.73
|
| Rate for Payer: UHC Core |
$1,185.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.11
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,285.20
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$305.24 |
| Max. Negotiated Rate |
$1,156.68 |
| Rate for Payer: Aetna Commercial |
$1,092.42
|
| Rate for Payer: Aetna Medicare |
$334.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$401.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$401.62
|
| Rate for Payer: BCBS Complete |
$514.08
|
| Rate for Payer: BCBS MAPPO |
$321.30
|
| Rate for Payer: BCBS Trust/PPO |
$999.24
|
| Rate for Payer: BCN Commercial |
$999.24
|
| Rate for Payer: BCN Medicare Advantage |
$321.30
|
| Rate for Payer: Cash Price |
$1,028.16
|
| Rate for Payer: Cofinity Commercial |
$1,105.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,028.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$321.30
|
| Rate for Payer: Healthscope Commercial |
$1,156.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$963.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$337.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$369.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,092.42
|
| Rate for Payer: PACE Senior Care Partners |
$305.24
|
| Rate for Payer: PACE SWMI |
$321.30
|
| Rate for Payer: PHP Commercial |
$1,092.42
|
| Rate for Payer: PHP Medicare Advantage |
$321.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,118.12
|
| Rate for Payer: Priority Health Medicare |
$321.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.84
|
| Rate for Payer: Railroad Medicare Medicare |
$321.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,130.98
|
| Rate for Payer: UHC Core |
$1,073.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$321.30
|
| Rate for Payer: UHC Medicare Advantage |
$330.94
|
| Rate for Payer: VA VA |
$321.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$963.90
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,285.20
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$783.84 |
| Max. Negotiated Rate |
$1,156.68 |
| Rate for Payer: Aetna Commercial |
$1,092.42
|
| Rate for Payer: BCBS Trust/PPO |
$993.20
|
| Rate for Payer: BCN Commercial |
$993.20
|
| Rate for Payer: Cash Price |
$1,028.16
|
| Rate for Payer: Cofinity Commercial |
$1,105.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,028.16
|
| Rate for Payer: Healthscope Commercial |
$1,156.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,092.42
|
| Rate for Payer: PHP Commercial |
$1,092.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,118.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,130.98
|
| Rate for Payer: UHC Core |
$1,073.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$963.90
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$243.20 |
| Max. Negotiated Rate |
$921.60 |
| Rate for Payer: Aetna Commercial |
$870.40
|
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna Medicare |
$266.24
|
| Rate for Payer: Aetna Medicare |
$181.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$320.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$320.00
|
| Rate for Payer: BCBS Complete |
$409.60
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS MAPPO |
$174.16
|
| Rate for Payer: BCBS MAPPO |
$256.00
|
| Rate for Payer: BCBS Trust/PPO |
$541.65
|
| Rate for Payer: BCBS Trust/PPO |
$796.16
|
| Rate for Payer: BCN Commercial |
$796.16
|
| Rate for Payer: BCN Commercial |
$541.65
|
| Rate for Payer: BCN Medicare Advantage |
$174.16
|
| Rate for Payer: BCN Medicare Advantage |
$256.00
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Cofinity Commercial |
$880.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.16
|
| Rate for Payer: Healthscope Commercial |
$921.60
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$768.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$182.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.40
|
| Rate for Payer: PACE Senior Care Partners |
$165.46
|
| Rate for Payer: PACE Senior Care Partners |
$243.20
|
| Rate for Payer: PACE SWMI |
$256.00
|
| Rate for Payer: PACE SWMI |
$174.16
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: PHP Commercial |
$870.40
|
| Rate for Payer: PHP Medicare Advantage |
$174.16
|
| Rate for Payer: PHP Medicare Advantage |
$256.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$890.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$606.09
|
| Rate for Payer: Priority Health Medicare |
$174.16
|
| Rate for Payer: Priority Health Medicare |
$256.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$424.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$624.54
|
| Rate for Payer: Railroad Medicare Medicare |
$256.00
|
| Rate for Payer: Railroad Medicare Medicare |
$174.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$901.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$613.06
|
| Rate for Payer: UHC Core |
$581.71
|
| Rate for Payer: UHC Core |
$855.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.16
|
| Rate for Payer: UHC Medicare Advantage |
$179.39
|
| Rate for Payer: UHC Medicare Advantage |
$263.68
|
| Rate for Payer: VA VA |
$256.00
|
| Rate for Payer: VA VA |
$174.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$768.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.50
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
IP
|
$696.66
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$424.89 |
| Max. Negotiated Rate |
$626.99 |
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna Commercial |
$870.40
|
| Rate for Payer: BCBS Trust/PPO |
$791.35
|
| Rate for Payer: BCBS Trust/PPO |
$538.38
|
| Rate for Payer: BCN Commercial |
$791.35
|
| Rate for Payer: BCN Commercial |
$538.38
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cofinity Commercial |
$880.64
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.20
|
| Rate for Payer: Healthscope Commercial |
$921.60
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$768.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: PHP Commercial |
$870.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$890.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$606.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$624.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$424.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$901.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$613.06
|
| Rate for Payer: UHC Core |
$855.04
|
| Rate for Payer: UHC Core |
$581.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$768.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.50
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
IP
|
$1,174.02
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$716.03 |
| Max. Negotiated Rate |
$1,056.62 |
| Rate for Payer: Aetna Commercial |
$997.92
|
| Rate for Payer: Aetna Commercial |
$2,003.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,821.49
|
| Rate for Payer: BCBS Trust/PPO |
$907.28
|
| Rate for Payer: BCN Commercial |
$907.28
|
| Rate for Payer: BCN Commercial |
$1,821.49
|
| Rate for Payer: Cash Price |
$939.22
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cofinity Commercial |
$1,009.66
|
| Rate for Payer: Cofinity Commercial |
$2,027.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,885.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.22
|
| Rate for Payer: Healthscope Commercial |
$2,121.30
|
| Rate for Payer: Healthscope Commercial |
$1,056.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,767.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,003.45
|
| Rate for Payer: PHP Commercial |
$997.92
|
| Rate for Payer: PHP Commercial |
$2,003.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,649.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,050.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$716.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,437.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,074.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,033.14
|
| Rate for Payer: UHC Core |
$980.31
|
| Rate for Payer: UHC Core |
$1,968.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,767.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.52
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
OP
|
$2,357.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$559.79 |
| Max. Negotiated Rate |
$2,121.30 |
| Rate for Payer: Aetna Commercial |
$2,003.45
|
| Rate for Payer: Aetna Commercial |
$997.92
|
| Rate for Payer: Aetna Medicare |
$612.82
|
| Rate for Payer: Aetna Medicare |
$305.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$366.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$736.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$736.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$366.88
|
| Rate for Payer: BCBS Complete |
$469.61
|
| Rate for Payer: BCBS Complete |
$942.80
|
| Rate for Payer: BCBS MAPPO |
$589.25
|
| Rate for Payer: BCBS MAPPO |
$293.50
|
| Rate for Payer: BCBS Trust/PPO |
$912.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,832.57
|
| Rate for Payer: BCN Commercial |
$1,832.57
|
| Rate for Payer: BCN Commercial |
$912.80
|
| Rate for Payer: BCN Medicare Advantage |
$293.50
|
| Rate for Payer: BCN Medicare Advantage |
$589.25
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cash Price |
$939.22
|
| Rate for Payer: Cofinity Commercial |
$2,027.02
|
| Rate for Payer: Cofinity Commercial |
$1,009.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,885.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.25
|
| Rate for Payer: Healthscope Commercial |
$2,121.30
|
| Rate for Payer: Healthscope Commercial |
$1,056.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,767.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$618.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$308.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$677.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,003.45
|
| Rate for Payer: PACE Senior Care Partners |
$278.83
|
| Rate for Payer: PACE Senior Care Partners |
$559.79
|
| Rate for Payer: PACE SWMI |
$589.25
|
| Rate for Payer: PACE SWMI |
$293.50
|
| Rate for Payer: PHP Commercial |
$997.92
|
| Rate for Payer: PHP Commercial |
$2,003.45
|
| Rate for Payer: PHP Medicare Advantage |
$589.25
|
| Rate for Payer: PHP Medicare Advantage |
$293.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,649.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,050.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.40
|
| Rate for Payer: Priority Health Medicare |
$589.25
|
| Rate for Payer: Priority Health Medicare |
$293.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,437.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$716.03
|
| Rate for Payer: Railroad Medicare Medicare |
$589.25
|
| Rate for Payer: Railroad Medicare Medicare |
$293.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,033.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,074.16
|
| Rate for Payer: UHC Core |
$980.31
|
| Rate for Payer: UHC Core |
$1,968.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$293.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$589.25
|
| Rate for Payer: UHC Medicare Advantage |
$606.93
|
| Rate for Payer: UHC Medicare Advantage |
$302.31
|
| Rate for Payer: VA VA |
$293.50
|
| Rate for Payer: VA VA |
$589.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,767.75
|
|
|
HC CT HEAD ANGIO
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna Medicare |
$278.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$334.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$334.69
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$267.75
|
| Rate for Payer: BCBS Trust/PPO |
$832.70
|
| Rate for Payer: BCN Commercial |
$832.70
|
| Rate for Payer: BCN Medicare Advantage |
$267.75
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.75
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$281.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$307.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PACE Senior Care Partners |
$254.36
|
| Rate for Payer: PACE SWMI |
$267.75
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: PHP Medicare Advantage |
$267.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$931.77
|
| Rate for Payer: Priority Health Medicare |
$267.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.20
|
| Rate for Payer: Railroad Medicare Medicare |
$267.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$942.48
|
| Rate for Payer: UHC Core |
$894.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.75
|
| Rate for Payer: UHC Medicare Advantage |
$275.78
|
| Rate for Payer: VA VA |
$267.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
HC CT HEAD ANGIO
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$653.20 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: BCBS Trust/PPO |
$827.67
|
| Rate for Payer: BCN Commercial |
$827.67
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$931.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$942.48
|
| Rate for Payer: UHC Core |
$894.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
HC CT HEART SCAN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$121.98 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$154.56
|
| Rate for Payer: BCN Commercial |
$154.56
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
HC CT HEART SCAN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.50
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$155.50
|
| Rate for Payer: BCN Commercial |
$155.50
|
| Rate for Payer: BCN Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PACE Senior Care Partners |
$47.50
|
| Rate for Payer: PACE SWMI |
$50.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Medicare Advantage |
$50.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.00
|
| Rate for Payer: Priority Health Medicare |
$50.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.98
|
| Rate for Payer: Railroad Medicare Medicare |
$50.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.00
|
| Rate for Payer: UHC Medicare Advantage |
$51.50
|
| Rate for Payer: VA VA |
$50.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
IP
|
$1,326.80
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$809.22 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.35
|
| Rate for Payer: BCN Commercial |
$1,025.35
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,127.78
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,154.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$809.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,167.58
|
| Rate for Payer: UHC Core |
$1,107.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.10
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
OP
|
$1,326.80
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: Aetna Medicare |
$344.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$414.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$414.62
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$331.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,031.59
|
| Rate for Payer: BCN Commercial |
$1,031.59
|
| Rate for Payer: BCN Medicare Advantage |
$331.70
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.70
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.10
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$348.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$381.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,127.78
|
| Rate for Payer: PACE Senior Care Partners |
$315.12
|
| Rate for Payer: PACE SWMI |
$331.70
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| Rate for Payer: PHP Medicare Advantage |
$331.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,154.32
|
| Rate for Payer: Priority Health Medicare |
$331.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$809.22
|
| Rate for Payer: Railroad Medicare Medicare |
$331.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,167.58
|
| Rate for Payer: UHC Core |
$1,107.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$331.70
|
| Rate for Payer: UHC Medicare Advantage |
$341.65
|
| Rate for Payer: VA VA |
$331.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.10
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$825.40 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,045.86
|
| Rate for Payer: BCN Commercial |
$1,045.86
|
| 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: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.34
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| 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 Narrow/Tiered Network |
$825.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.94
|
| Rate for Payer: UHC Core |
$1,130.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.00
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
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
|
|
