|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
IP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$421.84 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: BCBS Trust/PPO |
$534.51
|
| Rate for Payer: BCN Commercial |
$534.51
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
OP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna Medicare |
$179.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.14
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$172.92
|
| Rate for Payer: BCBS Trust/PPO |
$537.77
|
| Rate for Payer: BCN Commercial |
$537.77
|
| Rate for Payer: BCN Medicare Advantage |
$172.92
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.92
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PACE Senior Care Partners |
$164.27
|
| Rate for Payer: PACE SWMI |
$172.92
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: PHP Medicare Advantage |
$172.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.74
|
| Rate for Payer: Priority Health Medicare |
$172.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.84
|
| Rate for Payer: Railroad Medicare Medicare |
$172.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.92
|
| Rate for Payer: UHC Medicare Advantage |
$178.10
|
| Rate for Payer: VA VA |
$172.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
OP
|
$1,866.80
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,680.12 |
| Rate for Payer: Aetna Commercial |
$1,586.78
|
| Rate for Payer: Aetna Medicare |
$485.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$583.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$583.38
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$466.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,451.44
|
| Rate for Payer: BCN Commercial |
$1,451.44
|
| Rate for Payer: BCN Medicare Advantage |
$466.70
|
| Rate for Payer: Cash Price |
$1,493.44
|
| Rate for Payer: Cash Price |
$1,493.44
|
| Rate for Payer: Cofinity Commercial |
$1,605.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,493.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.70
|
| Rate for Payer: Healthscope Commercial |
$1,680.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,400.10
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$490.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$536.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,586.78
|
| Rate for Payer: PACE Senior Care Partners |
$443.36
|
| Rate for Payer: PACE SWMI |
$466.70
|
| Rate for Payer: PHP Commercial |
$1,586.78
|
| Rate for Payer: PHP Medicare Advantage |
$466.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,624.12
|
| Rate for Payer: Priority Health Medicare |
$466.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,138.56
|
| Rate for Payer: Railroad Medicare Medicare |
$466.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,642.78
|
| Rate for Payer: UHC Core |
$1,558.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.70
|
| Rate for Payer: UHC Medicare Advantage |
$480.70
|
| Rate for Payer: VA VA |
$466.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,400.10
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
IP
|
$1,866.80
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,138.56 |
| Max. Negotiated Rate |
$1,680.12 |
| Rate for Payer: Aetna Commercial |
$1,586.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,442.66
|
| Rate for Payer: BCN Commercial |
$1,442.66
|
| Rate for Payer: Cash Price |
$1,493.44
|
| Rate for Payer: Cofinity Commercial |
$1,605.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,493.44
|
| Rate for Payer: Healthscope Commercial |
$1,680.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,400.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,586.78
|
| Rate for Payer: PHP Commercial |
$1,586.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,624.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,138.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,642.78
|
| Rate for Payer: UHC Core |
$1,558.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,400.10
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
IP
|
$1,579.78
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$963.51 |
| Max. Negotiated Rate |
$1,421.80 |
| Rate for Payer: Aetna Commercial |
$1,342.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.85
|
| Rate for Payer: BCN Commercial |
$1,220.85
|
| Rate for Payer: Cash Price |
$1,263.82
|
| Rate for Payer: Cofinity Commercial |
$1,358.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.82
|
| Rate for Payer: Healthscope Commercial |
$1,421.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,184.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.81
|
| Rate for Payer: PHP Commercial |
$1,342.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,374.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$963.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,390.21
|
| Rate for Payer: UHC Core |
$1,319.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,184.84
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
OP
|
$1,579.78
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,421.80 |
| Rate for Payer: Aetna Commercial |
$1,342.81
|
| Rate for Payer: Aetna Medicare |
$410.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$493.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$493.68
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$394.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.28
|
| Rate for Payer: BCN Commercial |
$1,228.28
|
| Rate for Payer: BCN Medicare Advantage |
$394.94
|
| Rate for Payer: Cash Price |
$1,263.82
|
| Rate for Payer: Cash Price |
$1,263.82
|
| Rate for Payer: Cofinity Commercial |
$1,358.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.94
|
| Rate for Payer: Healthscope Commercial |
$1,421.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,184.84
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$414.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$454.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.81
|
| Rate for Payer: PACE Senior Care Partners |
$375.20
|
| Rate for Payer: PACE SWMI |
$394.94
|
| Rate for Payer: PHP Commercial |
$1,342.81
|
| Rate for Payer: PHP Medicare Advantage |
$394.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,374.41
|
| Rate for Payer: Priority Health Medicare |
$394.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$963.51
|
| Rate for Payer: Railroad Medicare Medicare |
$394.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,390.21
|
| Rate for Payer: UHC Core |
$1,319.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.94
|
| Rate for Payer: UHC Medicare Advantage |
$406.79
|
| Rate for Payer: VA VA |
$394.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,184.84
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
IP
|
$1,349.46
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$823.04 |
| Max. Negotiated Rate |
$1,214.51 |
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.86
|
| Rate for Payer: BCN Commercial |
$1,042.86
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cofinity Commercial |
$1,160.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Healthscope Commercial |
$1,214.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.04
|
| Rate for Payer: PHP Commercial |
$1,147.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$823.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.52
|
| Rate for Payer: UHC Core |
$1,126.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.10
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
OP
|
$1,349.46
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$1,214.51 |
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: Aetna Medicare |
$350.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$421.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$421.71
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$337.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.21
|
| Rate for Payer: BCN Commercial |
$1,049.21
|
| Rate for Payer: BCN Medicare Advantage |
$337.36
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cofinity Commercial |
$1,160.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.36
|
| Rate for Payer: Healthscope Commercial |
$1,214.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.10
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$354.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$387.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.04
|
| Rate for Payer: PACE Senior Care Partners |
$320.50
|
| Rate for Payer: PACE SWMI |
$337.36
|
| Rate for Payer: PHP Commercial |
$1,147.04
|
| Rate for Payer: PHP Medicare Advantage |
$337.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.03
|
| Rate for Payer: Priority Health Medicare |
$337.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$823.04
|
| Rate for Payer: Railroad Medicare Medicare |
$337.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.52
|
| Rate for Payer: UHC Core |
$1,126.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.36
|
| Rate for Payer: UHC Medicare Advantage |
$347.49
|
| Rate for Payer: VA VA |
$337.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.10
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
OP
|
$1,711.50
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,540.35 |
| Rate for Payer: Aetna Commercial |
$1,454.78
|
| Rate for Payer: Aetna Medicare |
$444.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$534.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$534.84
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$427.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,330.69
|
| Rate for Payer: BCN Commercial |
$1,330.69
|
| Rate for Payer: BCN Medicare Advantage |
$427.88
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,471.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,369.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.88
|
| Rate for Payer: Healthscope Commercial |
$1,540.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,283.62
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$449.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$492.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: PACE Senior Care Partners |
$406.48
|
| Rate for Payer: PACE SWMI |
$427.88
|
| Rate for Payer: PHP Commercial |
$1,454.78
|
| Rate for Payer: PHP Medicare Advantage |
$427.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,489.00
|
| Rate for Payer: Priority Health Medicare |
$427.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,043.84
|
| Rate for Payer: Railroad Medicare Medicare |
$427.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,506.12
|
| Rate for Payer: UHC Core |
$1,429.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.88
|
| Rate for Payer: UHC Medicare Advantage |
$440.71
|
| Rate for Payer: VA VA |
$427.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,283.62
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
IP
|
$1,711.50
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,043.84 |
| Max. Negotiated Rate |
$1,540.35 |
| Rate for Payer: Aetna Commercial |
$1,454.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,322.65
|
| Rate for Payer: BCN Commercial |
$1,322.65
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,471.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,369.20
|
| Rate for Payer: Healthscope Commercial |
$1,540.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,283.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: PHP Commercial |
$1,454.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,489.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,043.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,506.12
|
| Rate for Payer: UHC Core |
$1,429.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,283.62
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
IP
|
$2,020.91
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,232.55 |
| Max. Negotiated Rate |
$1,818.82 |
| Rate for Payer: Aetna Commercial |
$1,717.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,561.76
|
| Rate for Payer: BCN Commercial |
$1,561.76
|
| Rate for Payer: Cash Price |
$1,616.73
|
| Rate for Payer: Cofinity Commercial |
$1,737.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,616.73
|
| Rate for Payer: Healthscope Commercial |
$1,818.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,515.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,717.77
|
| Rate for Payer: PHP Commercial |
$1,717.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,758.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,232.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,778.40
|
| Rate for Payer: UHC Core |
$1,687.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,515.68
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
OP
|
$2,020.91
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,818.82 |
| Rate for Payer: Aetna Commercial |
$1,717.77
|
| Rate for Payer: Aetna Medicare |
$525.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$631.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$631.53
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$505.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,571.26
|
| Rate for Payer: BCN Commercial |
$1,571.26
|
| Rate for Payer: BCN Medicare Advantage |
$505.23
|
| Rate for Payer: Cash Price |
$1,616.73
|
| Rate for Payer: Cash Price |
$1,616.73
|
| Rate for Payer: Cofinity Commercial |
$1,737.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,616.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$505.23
|
| Rate for Payer: Healthscope Commercial |
$1,818.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,515.68
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$530.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$581.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,717.77
|
| Rate for Payer: PACE Senior Care Partners |
$479.97
|
| Rate for Payer: PACE SWMI |
$505.23
|
| Rate for Payer: PHP Commercial |
$1,717.77
|
| Rate for Payer: PHP Medicare Advantage |
$505.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,758.19
|
| Rate for Payer: Priority Health Medicare |
$505.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,232.55
|
| Rate for Payer: Railroad Medicare Medicare |
$505.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,778.40
|
| Rate for Payer: UHC Core |
$1,687.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$505.23
|
| Rate for Payer: UHC Medicare Advantage |
$520.38
|
| Rate for Payer: VA VA |
$505.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,515.68
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
IP
|
$1,711.50
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,043.84 |
| Max. Negotiated Rate |
$1,540.35 |
| Rate for Payer: Aetna Commercial |
$1,454.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,322.65
|
| Rate for Payer: BCN Commercial |
$1,322.65
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,471.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,369.20
|
| Rate for Payer: Healthscope Commercial |
$1,540.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,283.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: PHP Commercial |
$1,454.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,489.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,043.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,506.12
|
| Rate for Payer: UHC Core |
$1,429.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,283.62
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
OP
|
$1,711.50
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$1,540.35 |
| Rate for Payer: Aetna Commercial |
$1,454.78
|
| Rate for Payer: Aetna Medicare |
$444.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$534.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$534.84
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$427.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,330.69
|
| Rate for Payer: BCN Commercial |
$1,330.69
|
| Rate for Payer: BCN Medicare Advantage |
$427.88
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,471.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,369.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.88
|
| Rate for Payer: Healthscope Commercial |
$1,540.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,283.62
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$449.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$492.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: PACE Senior Care Partners |
$406.48
|
| Rate for Payer: PACE SWMI |
$427.88
|
| Rate for Payer: PHP Commercial |
$1,454.78
|
| Rate for Payer: PHP Medicare Advantage |
$427.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,489.00
|
| Rate for Payer: Priority Health Medicare |
$427.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,043.84
|
| Rate for Payer: Railroad Medicare Medicare |
$427.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,506.12
|
| Rate for Payer: UHC Core |
$1,429.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.88
|
| Rate for Payer: UHC Medicare Advantage |
$440.71
|
| Rate for Payer: VA VA |
$427.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,283.62
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
OP
|
$2,618.59
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$2,356.73 |
| Rate for Payer: Aetna Commercial |
$2,225.80
|
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: Aetna Medicare |
$680.83
|
| Rate for Payer: Aetna Medicare |
$453.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$545.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$818.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$545.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$818.31
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$654.65
|
| Rate for Payer: BCBS MAPPO |
$436.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,357.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,035.95
|
| Rate for Payer: BCN Commercial |
$2,035.95
|
| Rate for Payer: BCN Commercial |
$1,357.31
|
| Rate for Payer: BCN Medicare Advantage |
$436.43
|
| Rate for Payer: BCN Medicare Advantage |
$654.65
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$2,094.87
|
| Rate for Payer: Cash Price |
$2,094.87
|
| Rate for Payer: Cofinity Commercial |
$2,251.99
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,094.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.65
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| Rate for Payer: Healthscope Commercial |
$2,356.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,963.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,309.30
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$687.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$458.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$501.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,225.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,483.87
|
| Rate for Payer: PACE Senior Care Partners |
$414.61
|
| Rate for Payer: PACE Senior Care Partners |
$621.92
|
| Rate for Payer: PACE SWMI |
$654.65
|
| Rate for Payer: PACE SWMI |
$436.43
|
| Rate for Payer: PHP Commercial |
$2,225.80
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: PHP Medicare Advantage |
$436.43
|
| Rate for Payer: PHP Medicare Advantage |
$654.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,833.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,278.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,518.79
|
| Rate for Payer: Priority Health Medicare |
$654.65
|
| Rate for Payer: Priority Health Medicare |
$436.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,064.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,597.08
|
| Rate for Payer: Railroad Medicare Medicare |
$436.43
|
| Rate for Payer: Railroad Medicare Medicare |
$654.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,304.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,536.24
|
| Rate for Payer: UHC Core |
$2,186.52
|
| Rate for Payer: UHC Core |
$1,457.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$654.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.43
|
| Rate for Payer: UHC Medicare Advantage |
$449.53
|
| Rate for Payer: UHC Medicare Advantage |
$674.29
|
| Rate for Payer: VA VA |
$436.43
|
| Rate for Payer: VA VA |
$654.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,309.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,963.94
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
IP
|
$2,618.59
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,597.08 |
| Max. Negotiated Rate |
$2,356.73 |
| Rate for Payer: Aetna Commercial |
$2,225.80
|
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,349.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,023.65
|
| Rate for Payer: BCN Commercial |
$1,349.10
|
| Rate for Payer: BCN Commercial |
$2,023.65
|
| Rate for Payer: Cash Price |
$2,094.87
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cofinity Commercial |
$2,251.99
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,094.87
|
| Rate for Payer: Healthscope Commercial |
$2,356.73
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,309.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,963.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,483.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,225.80
|
| Rate for Payer: PHP Commercial |
$2,225.80
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,833.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,278.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,518.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,064.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,597.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,304.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,536.24
|
| Rate for Payer: UHC Core |
$1,457.68
|
| Rate for Payer: UHC Core |
$2,186.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,309.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,963.94
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
IP
|
$1,515.31
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$924.19 |
| Max. Negotiated Rate |
$1,363.78 |
| Rate for Payer: Aetna Commercial |
$1,288.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,171.03
|
| Rate for Payer: BCN Commercial |
$1,171.03
|
| Rate for Payer: Cash Price |
$1,212.25
|
| Rate for Payer: Cofinity Commercial |
$1,303.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,212.25
|
| Rate for Payer: Healthscope Commercial |
$1,363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,136.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,288.01
|
| Rate for Payer: PHP Commercial |
$1,288.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,318.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$924.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,333.47
|
| Rate for Payer: UHC Core |
$1,265.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,136.48
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
OP
|
$1,515.31
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,363.78 |
| Rate for Payer: Aetna Commercial |
$1,288.01
|
| Rate for Payer: Aetna Medicare |
$393.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$473.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$473.53
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$378.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,178.15
|
| Rate for Payer: BCN Commercial |
$1,178.15
|
| Rate for Payer: BCN Medicare Advantage |
$378.83
|
| Rate for Payer: Cash Price |
$1,212.25
|
| Rate for Payer: Cash Price |
$1,212.25
|
| Rate for Payer: Cofinity Commercial |
$1,303.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,212.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.83
|
| Rate for Payer: Healthscope Commercial |
$1,363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,136.48
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$397.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$435.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,288.01
|
| Rate for Payer: PACE Senior Care Partners |
$359.89
|
| Rate for Payer: PACE SWMI |
$378.83
|
| Rate for Payer: PHP Commercial |
$1,288.01
|
| Rate for Payer: PHP Medicare Advantage |
$378.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,318.32
|
| Rate for Payer: Priority Health Medicare |
$378.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$924.19
|
| Rate for Payer: Railroad Medicare Medicare |
$378.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,333.47
|
| Rate for Payer: UHC Core |
$1,265.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.83
|
| Rate for Payer: UHC Medicare Advantage |
$390.19
|
| Rate for Payer: VA VA |
$378.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,136.48
|
|
|
HC CT LOWER EXTREM WO CON
|
Facility
|
IP
|
$2,024.19
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,234.55 |
| Max. Negotiated Rate |
$1,821.77 |
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,564.29
|
| Rate for Payer: BCN Commercial |
$1,042.86
|
| Rate for Payer: BCN Commercial |
$1,564.29
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$1,160.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Healthscope Commercial |
$1,214.51
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,518.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: PHP Commercial |
$1,147.04
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,761.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$823.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,234.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,781.29
|
| Rate for Payer: UHC Core |
$1,690.20
|
| Rate for Payer: UHC Core |
$1,126.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.14
|
|
|
HC CT LOWER EXTREM WO CON
|
Facility
|
OP
|
$1,349.46
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$1,214.51 |
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: Aetna Medicare |
$350.86
|
| Rate for Payer: Aetna Medicare |
$526.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$421.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$632.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$632.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$421.71
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$337.36
|
| Rate for Payer: BCBS MAPPO |
$506.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,573.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.21
|
| Rate for Payer: BCN Commercial |
$1,573.81
|
| Rate for Payer: BCN Commercial |
$1,049.21
|
| Rate for Payer: BCN Medicare Advantage |
$506.05
|
| Rate for Payer: BCN Medicare Advantage |
$337.36
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$1,160.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$506.05
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Healthscope Commercial |
$1,214.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,518.14
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$354.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$531.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$581.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$387.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: PACE Senior Care Partners |
$480.75
|
| Rate for Payer: PACE Senior Care Partners |
$320.50
|
| Rate for Payer: PACE SWMI |
$337.36
|
| Rate for Payer: PACE SWMI |
$506.05
|
| Rate for Payer: PHP Commercial |
$1,147.04
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: PHP Medicare Advantage |
$506.05
|
| Rate for Payer: PHP Medicare Advantage |
$337.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,761.05
|
| Rate for Payer: Priority Health Medicare |
$337.36
|
| Rate for Payer: Priority Health Medicare |
$506.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,234.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$823.04
|
| Rate for Payer: Railroad Medicare Medicare |
$506.05
|
| Rate for Payer: Railroad Medicare Medicare |
$337.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,781.29
|
| Rate for Payer: UHC Core |
$1,126.80
|
| Rate for Payer: UHC Core |
$1,690.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$506.05
|
| Rate for Payer: UHC Medicare Advantage |
$521.23
|
| Rate for Payer: UHC Medicare Advantage |
$347.49
|
| Rate for Payer: VA VA |
$337.36
|
| Rate for Payer: VA VA |
$506.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.14
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
OP
|
$1,037.49
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$933.74 |
| Rate for Payer: Aetna Commercial |
$881.87
|
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna Medicare |
$269.75
|
| Rate for Payer: Aetna Medicare |
$179.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$324.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$324.22
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$172.92
|
| Rate for Payer: BCBS MAPPO |
$259.37
|
| Rate for Payer: BCBS Trust/PPO |
$806.65
|
| Rate for Payer: BCBS Trust/PPO |
$537.77
|
| Rate for Payer: BCN Commercial |
$806.65
|
| Rate for Payer: BCN Commercial |
$537.77
|
| Rate for Payer: BCN Medicare Advantage |
$259.37
|
| Rate for Payer: BCN Medicare Advantage |
$172.92
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$892.24
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.92
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Healthscope Commercial |
$933.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$778.12
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$272.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$881.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PACE Senior Care Partners |
$246.40
|
| Rate for Payer: PACE Senior Care Partners |
$164.27
|
| Rate for Payer: PACE SWMI |
$259.37
|
| Rate for Payer: PACE SWMI |
$172.92
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: PHP Commercial |
$881.87
|
| Rate for Payer: PHP Medicare Advantage |
$172.92
|
| Rate for Payer: PHP Medicare Advantage |
$259.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$726.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$902.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.74
|
| Rate for Payer: Priority Health Medicare |
$172.92
|
| Rate for Payer: Priority Health Medicare |
$259.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$632.77
|
| Rate for Payer: Railroad Medicare Medicare |
$172.92
|
| Rate for Payer: Railroad Medicare Medicare |
$259.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$912.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: UHC Core |
$866.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.92
|
| Rate for Payer: UHC Medicare Advantage |
$267.15
|
| Rate for Payer: UHC Medicare Advantage |
$178.10
|
| Rate for Payer: VA VA |
$172.92
|
| Rate for Payer: VA VA |
$259.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$778.12
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
IP
|
$1,037.49
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$632.77 |
| Max. Negotiated Rate |
$933.74 |
| Rate for Payer: Aetna Commercial |
$881.87
|
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: BCBS Trust/PPO |
$801.77
|
| Rate for Payer: BCBS Trust/PPO |
$534.51
|
| Rate for Payer: BCN Commercial |
$534.51
|
| Rate for Payer: BCN Commercial |
$801.77
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cofinity Commercial |
$892.24
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.99
|
| Rate for Payer: Healthscope Commercial |
$933.74
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$778.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$881.87
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: PHP Commercial |
$881.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$726.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$902.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$632.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$912.99
|
| Rate for Payer: UHC Core |
$866.30
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$778.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
|
|
HC CT NECK ANGIO
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| 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 NECK ANGIO
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| 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 NEEDLE PLACE HEAD AND NECK
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$896.32 |
| Max. Negotiated Rate |
$4,033.68 |
| Rate for Payer: Aetna Commercial |
$3,207.90
|
| Rate for Payer: Aetna Medicare |
$981.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,179.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,179.38
|
| Rate for Payer: BCBS Complete |
$4,033.68
|
| Rate for Payer: BCBS MAPPO |
$943.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,934.28
|
| Rate for Payer: BCN Commercial |
$2,934.28
|
| Rate for Payer: BCN Medicare Advantage |
$943.50
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cofinity Commercial |
$3,245.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$943.50
|
| Rate for Payer: Healthscope Commercial |
$3,396.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,830.50
|
| Rate for Payer: Mclaren Medicaid |
$3,841.60
|
| Rate for Payer: Meridian Medicaid |
$4,033.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$990.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,085.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,207.90
|
| Rate for Payer: PACE Senior Care Partners |
$896.32
|
| Rate for Payer: PACE SWMI |
$943.50
|
| Rate for Payer: PHP Commercial |
$3,207.90
|
| Rate for Payer: PHP Medicare Advantage |
$943.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,841.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,283.38
|
| Rate for Payer: Priority Health Medicare |
$943.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,301.76
|
| Rate for Payer: Railroad Medicare Medicare |
$943.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,321.12
|
| Rate for Payer: UHC Core |
$3,151.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$943.50
|
| Rate for Payer: UHC Medicare Advantage |
$971.80
|
| Rate for Payer: VA VA |
$943.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,830.50
|
|
