|
HC CT HEART SCAN
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$165.18
|
| Rate for Payer: BCN Commercial |
$165.18
|
| 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 Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.20
|
| 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
|
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$35.26 |
| 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 |
$37.02
|
| Rate for Payer: BCBS MAPPO |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$164.42
|
| Rate for Payer: BCN Commercial |
$164.42
|
| Rate for Payer: BCN Medicare Advantage |
$50.00
|
| 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 |
$35.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.50
|
| Rate for Payer: Meridian Medicaid |
$37.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| 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 |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Medicare |
$50.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.20
|
| Rate for Payer: Railroad Medicare Medicare |
$50.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: UHC Exchange |
$50.00
|
| Rate for Payer: UHC Medicaid |
$35.26
|
| Rate for Payer: UHC Medicare Advantage |
$50.00
|
| Rate for Payer: UHCCP Medicaid |
$35.26
|
| 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
|
OP
|
$1,380.41
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$243.37 |
| Max. Negotiated Rate |
$1,242.37 |
| Rate for Payer: Aetna Commercial |
$1,173.35
|
| Rate for Payer: Aetna Medicare |
$358.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$431.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$431.38
|
| Rate for Payer: BCBS Complete |
$255.51
|
| Rate for Payer: BCBS MAPPO |
$345.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.84
|
| Rate for Payer: BCN Commercial |
$1,134.84
|
| Rate for Payer: BCN Medicare Advantage |
$345.10
|
| Rate for Payer: Cash Price |
$1,104.33
|
| Rate for Payer: Cofinity Commercial |
$1,187.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.10
|
| Rate for Payer: Healthscope Commercial |
$1,242.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.31
|
| Rate for Payer: Mclaren Medicaid |
$243.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.36
|
| Rate for Payer: Meridian Medicaid |
$255.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$379.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.35
|
| Rate for Payer: Nomi Health Commercial |
$1,131.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.31
|
| Rate for Payer: PACE Senior Care Partners |
$327.85
|
| Rate for Payer: PACE SWMI |
$345.10
|
| Rate for Payer: PHP Commercial |
$1,173.35
|
| Rate for Payer: PHP Medicare Advantage |
$345.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$243.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,200.96
|
| Rate for Payer: Priority Health Medicare |
$348.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$960.77
|
| Rate for Payer: Railroad Medicare Medicare |
$345.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,214.76
|
| Rate for Payer: UHC Core |
$1,152.64
|
| Rate for Payer: UHC Exchange |
$345.10
|
| Rate for Payer: UHC Medicaid |
$243.37
|
| Rate for Payer: UHC Medicare Advantage |
$345.10
|
| Rate for Payer: UHCCP Medicaid |
$243.37
|
| Rate for Payer: VA VA |
$345.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.31
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
IP
|
$1,380.41
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$960.77 |
| Max. Negotiated Rate |
$1,242.37 |
| Rate for Payer: Aetna Commercial |
$1,173.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.08
|
| Rate for Payer: BCN Commercial |
$1,140.08
|
| Rate for Payer: Cash Price |
$1,104.33
|
| Rate for Payer: Cofinity Commercial |
$1,187.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.33
|
| Rate for Payer: Healthscope Commercial |
$1,242.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.35
|
| Rate for Payer: Nomi Health Commercial |
$1,131.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.31
|
| Rate for Payer: PHP Commercial |
$1,173.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,200.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$960.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,214.76
|
| Rate for Payer: UHC Core |
$1,152.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.31
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
IP
|
$1,408.02
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.98 |
| Max. Negotiated Rate |
$1,267.22 |
| Rate for Payer: Aetna Commercial |
$1,196.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,162.88
|
| Rate for Payer: BCN Commercial |
$1,162.88
|
| Rate for Payer: Cash Price |
$1,126.42
|
| Rate for Payer: Cofinity Commercial |
$1,210.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.42
|
| Rate for Payer: Healthscope Commercial |
$1,267.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,056.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,196.82
|
| Rate for Payer: Nomi Health Commercial |
$1,154.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,056.02
|
| Rate for Payer: PHP Commercial |
$1,196.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,224.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$979.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,239.06
|
| Rate for Payer: UHC Core |
$1,175.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,056.02
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
OP
|
$1,408.02
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$248.23 |
| Max. Negotiated Rate |
$1,267.22 |
| Rate for Payer: Aetna Commercial |
$1,196.82
|
| Rate for Payer: Aetna Medicare |
$366.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.01
|
| Rate for Payer: BCBS Complete |
$260.62
|
| Rate for Payer: BCBS MAPPO |
$352.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,157.53
|
| Rate for Payer: BCN Commercial |
$1,157.53
|
| Rate for Payer: BCN Medicare Advantage |
$352.00
|
| Rate for Payer: Cash Price |
$1,126.42
|
| Rate for Payer: Cofinity Commercial |
$1,210.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.00
|
| Rate for Payer: Healthscope Commercial |
$1,267.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,056.02
|
| Rate for Payer: Mclaren Medicaid |
$248.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.61
|
| Rate for Payer: Meridian Medicaid |
$260.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$404.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$387.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,196.82
|
| Rate for Payer: Nomi Health Commercial |
$1,154.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,056.02
|
| Rate for Payer: PACE Senior Care Partners |
$334.40
|
| Rate for Payer: PACE SWMI |
$352.00
|
| Rate for Payer: PHP Commercial |
$1,196.82
|
| Rate for Payer: PHP Medicare Advantage |
$352.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$248.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,224.98
|
| Rate for Payer: Priority Health Medicare |
$355.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$979.98
|
| Rate for Payer: Railroad Medicare Medicare |
$352.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,239.06
|
| Rate for Payer: UHC Core |
$1,175.70
|
| Rate for Payer: UHC Exchange |
$352.00
|
| Rate for Payer: UHC Medicaid |
$248.23
|
| Rate for Payer: UHC Medicare Advantage |
$352.00
|
| Rate for Payer: UHCCP Medicaid |
$248.23
|
| Rate for Payer: VA VA |
$352.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,056.02
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
OP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$126.87 |
| Max. Negotiated Rate |
$647.64 |
| Rate for Payer: Aetna Commercial |
$611.66
|
| Rate for Payer: Aetna Medicare |
$187.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$224.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$224.88
|
| Rate for Payer: BCBS Complete |
$133.20
|
| Rate for Payer: BCBS MAPPO |
$179.90
|
| Rate for Payer: BCBS Trust/PPO |
$591.58
|
| Rate for Payer: BCN Commercial |
$591.58
|
| Rate for Payer: BCN Medicare Advantage |
$179.90
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Commercial |
$618.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.90
|
| Rate for Payer: Healthscope Commercial |
$647.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$539.70
|
| Rate for Payer: Mclaren Medicaid |
$126.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.90
|
| Rate for Payer: Meridian Medicaid |
$133.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$197.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Nomi Health Commercial |
$590.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: PACE Senior Care Partners |
$170.91
|
| Rate for Payer: PACE SWMI |
$179.90
|
| Rate for Payer: PHP Commercial |
$611.66
|
| Rate for Payer: PHP Medicare Advantage |
$179.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$626.05
|
| Rate for Payer: Priority Health Medicare |
$181.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$500.84
|
| Rate for Payer: Railroad Medicare Medicare |
$179.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.25
|
| Rate for Payer: UHC Core |
$600.87
|
| Rate for Payer: UHC Exchange |
$179.90
|
| Rate for Payer: UHC Medicaid |
$126.87
|
| Rate for Payer: UHC Medicare Advantage |
$179.90
|
| Rate for Payer: UHCCP Medicaid |
$126.87
|
| Rate for Payer: VA VA |
$179.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$539.70
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
IP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$500.84 |
| Max. Negotiated Rate |
$647.64 |
| Rate for Payer: Aetna Commercial |
$611.66
|
| Rate for Payer: BCBS Trust/PPO |
$594.32
|
| Rate for Payer: BCN Commercial |
$594.32
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Commercial |
$618.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Healthscope Commercial |
$647.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$539.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Nomi Health Commercial |
$590.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: PHP Commercial |
$611.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$626.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$500.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.25
|
| Rate for Payer: UHC Core |
$600.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$539.70
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
OP
|
$1,942.22
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$342.41 |
| Max. Negotiated Rate |
$1,748.00 |
| Rate for Payer: Aetna Commercial |
$1,650.89
|
| Rate for Payer: Aetna Medicare |
$504.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$606.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$606.94
|
| Rate for Payer: BCBS Complete |
$359.50
|
| Rate for Payer: BCBS MAPPO |
$485.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,596.70
|
| Rate for Payer: BCN Commercial |
$1,596.70
|
| Rate for Payer: BCN Medicare Advantage |
$485.56
|
| Rate for Payer: Cash Price |
$1,553.78
|
| Rate for Payer: Cofinity Commercial |
$1,670.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$485.56
|
| Rate for Payer: Healthscope Commercial |
$1,748.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,456.66
|
| Rate for Payer: Mclaren Medicaid |
$342.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$509.83
|
| Rate for Payer: Meridian Medicaid |
$359.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$558.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$534.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.89
|
| Rate for Payer: Nomi Health Commercial |
$1,592.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,456.66
|
| Rate for Payer: PACE Senior Care Partners |
$461.28
|
| Rate for Payer: PACE SWMI |
$485.56
|
| Rate for Payer: PHP Commercial |
$1,650.89
|
| Rate for Payer: PHP Medicare Advantage |
$485.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,689.73
|
| Rate for Payer: Priority Health Medicare |
$490.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,351.79
|
| Rate for Payer: Railroad Medicare Medicare |
$485.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,709.15
|
| Rate for Payer: UHC Core |
$1,621.75
|
| Rate for Payer: UHC Exchange |
$485.56
|
| Rate for Payer: UHC Medicaid |
$342.41
|
| Rate for Payer: UHC Medicare Advantage |
$485.56
|
| Rate for Payer: UHCCP Medicaid |
$342.41
|
| Rate for Payer: VA VA |
$485.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,456.66
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
IP
|
$1,942.22
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,351.79 |
| Max. Negotiated Rate |
$1,748.00 |
| Rate for Payer: Aetna Commercial |
$1,650.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.08
|
| Rate for Payer: BCN Commercial |
$1,604.08
|
| Rate for Payer: Cash Price |
$1,553.78
|
| Rate for Payer: Cofinity Commercial |
$1,670.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.78
|
| Rate for Payer: Healthscope Commercial |
$1,748.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,456.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.89
|
| Rate for Payer: Nomi Health Commercial |
$1,592.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,456.66
|
| Rate for Payer: PHP Commercial |
$1,650.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,689.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,351.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,709.15
|
| Rate for Payer: UHC Core |
$1,621.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,456.66
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
OP
|
$1,643.61
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$289.77 |
| Max. Negotiated Rate |
$1,479.25 |
| Rate for Payer: Aetna Commercial |
$1,397.07
|
| Rate for Payer: Aetna Medicare |
$427.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$513.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$513.63
|
| Rate for Payer: BCBS Complete |
$304.23
|
| Rate for Payer: BCBS MAPPO |
$410.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,351.21
|
| Rate for Payer: BCN Commercial |
$1,351.21
|
| Rate for Payer: BCN Medicare Advantage |
$410.90
|
| Rate for Payer: Cash Price |
$1,314.89
|
| Rate for Payer: Cofinity Commercial |
$1,413.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,314.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.90
|
| Rate for Payer: Healthscope Commercial |
$1,479.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,232.71
|
| Rate for Payer: Mclaren Medicaid |
$289.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$431.45
|
| Rate for Payer: Meridian Medicaid |
$304.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$472.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$451.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,397.07
|
| Rate for Payer: Nomi Health Commercial |
$1,347.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,232.71
|
| Rate for Payer: PACE Senior Care Partners |
$390.36
|
| Rate for Payer: PACE SWMI |
$410.90
|
| Rate for Payer: PHP Commercial |
$1,397.07
|
| Rate for Payer: PHP Medicare Advantage |
$410.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,429.94
|
| Rate for Payer: Priority Health Medicare |
$415.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,143.95
|
| Rate for Payer: Railroad Medicare Medicare |
$410.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,446.38
|
| Rate for Payer: UHC Core |
$1,372.41
|
| Rate for Payer: UHC Exchange |
$410.90
|
| Rate for Payer: UHC Medicaid |
$289.77
|
| Rate for Payer: UHC Medicare Advantage |
$410.90
|
| Rate for Payer: UHCCP Medicaid |
$289.77
|
| Rate for Payer: VA VA |
$410.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,232.71
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
IP
|
$1,643.61
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,143.95 |
| Max. Negotiated Rate |
$1,479.25 |
| Rate for Payer: Aetna Commercial |
$1,397.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,357.46
|
| Rate for Payer: BCN Commercial |
$1,357.46
|
| Rate for Payer: Cash Price |
$1,314.89
|
| Rate for Payer: Cofinity Commercial |
$1,413.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,314.89
|
| Rate for Payer: Healthscope Commercial |
$1,479.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,232.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,397.07
|
| Rate for Payer: Nomi Health Commercial |
$1,347.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,232.71
|
| Rate for Payer: PHP Commercial |
$1,397.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,429.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,143.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,446.38
|
| Rate for Payer: UHC Core |
$1,372.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,232.71
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
IP
|
$1,403.98
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$977.17 |
| Max. Negotiated Rate |
$1,263.58 |
| Rate for Payer: Aetna Commercial |
$1,193.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.55
|
| Rate for Payer: BCN Commercial |
$1,159.55
|
| Rate for Payer: Cash Price |
$1,123.18
|
| Rate for Payer: Cofinity Commercial |
$1,207.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.18
|
| Rate for Payer: Healthscope Commercial |
$1,263.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,052.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.38
|
| Rate for Payer: Nomi Health Commercial |
$1,151.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,052.98
|
| Rate for Payer: PHP Commercial |
$1,193.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,221.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$977.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,235.50
|
| Rate for Payer: UHC Core |
$1,172.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,052.98
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
OP
|
$1,403.98
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$247.52 |
| Max. Negotiated Rate |
$1,263.58 |
| Rate for Payer: Aetna Commercial |
$1,193.38
|
| Rate for Payer: Aetna Medicare |
$365.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$438.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$438.74
|
| Rate for Payer: BCBS Complete |
$259.88
|
| Rate for Payer: BCBS MAPPO |
$351.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,154.21
|
| Rate for Payer: BCN Commercial |
$1,154.21
|
| Rate for Payer: BCN Medicare Advantage |
$351.00
|
| Rate for Payer: Cash Price |
$1,123.18
|
| Rate for Payer: Cofinity Commercial |
$1,207.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.00
|
| Rate for Payer: Healthscope Commercial |
$1,263.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,052.98
|
| Rate for Payer: Mclaren Medicaid |
$247.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.54
|
| Rate for Payer: Meridian Medicaid |
$259.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$386.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.38
|
| Rate for Payer: Nomi Health Commercial |
$1,151.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,052.98
|
| Rate for Payer: PACE Senior Care Partners |
$333.45
|
| Rate for Payer: PACE SWMI |
$351.00
|
| Rate for Payer: PHP Commercial |
$1,193.38
|
| Rate for Payer: PHP Medicare Advantage |
$351.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,221.46
|
| Rate for Payer: Priority Health Medicare |
$354.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$977.17
|
| Rate for Payer: Railroad Medicare Medicare |
$351.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,235.50
|
| Rate for Payer: UHC Core |
$1,172.32
|
| Rate for Payer: UHC Exchange |
$351.00
|
| Rate for Payer: UHC Medicaid |
$247.52
|
| Rate for Payer: UHC Medicare Advantage |
$351.00
|
| Rate for Payer: UHCCP Medicaid |
$247.52
|
| Rate for Payer: VA VA |
$351.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,052.98
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
IP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,239.33 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,470.63
|
| Rate for Payer: BCN Commercial |
$1,470.63
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,335.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Nomi Health Commercial |
$1,460.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,549.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,239.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,566.96
|
| Rate for Payer: UHC Core |
$1,486.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,335.48
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
OP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$313.93 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: Aetna Medicare |
$462.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.45
|
| Rate for Payer: BCBS Complete |
$329.60
|
| Rate for Payer: BCBS MAPPO |
$445.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.86
|
| Rate for Payer: BCN Commercial |
$1,463.86
|
| Rate for Payer: BCN Medicare Advantage |
$445.16
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.16
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,335.48
|
| Rate for Payer: Mclaren Medicaid |
$313.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.42
|
| Rate for Payer: Meridian Medicaid |
$329.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Nomi Health Commercial |
$1,460.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: PACE Senior Care Partners |
$422.90
|
| Rate for Payer: PACE SWMI |
$445.16
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: PHP Medicare Advantage |
$445.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,549.16
|
| Rate for Payer: Priority Health Medicare |
$449.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,239.33
|
| Rate for Payer: Railroad Medicare Medicare |
$445.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,566.96
|
| Rate for Payer: UHC Core |
$1,486.83
|
| Rate for Payer: UHC Exchange |
$445.16
|
| Rate for Payer: UHC Medicaid |
$313.93
|
| Rate for Payer: UHC Medicare Advantage |
$445.16
|
| Rate for Payer: UHCCP Medicaid |
$313.93
|
| Rate for Payer: VA VA |
$445.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,335.48
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
IP
|
$2,102.56
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,463.38 |
| Max. Negotiated Rate |
$1,892.30 |
| Rate for Payer: Aetna Commercial |
$1,787.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,736.50
|
| Rate for Payer: BCN Commercial |
$1,736.50
|
| Rate for Payer: Cash Price |
$1,682.05
|
| Rate for Payer: Cofinity Commercial |
$1,808.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,682.05
|
| Rate for Payer: Healthscope Commercial |
$1,892.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,576.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,787.18
|
| Rate for Payer: Nomi Health Commercial |
$1,724.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.92
|
| Rate for Payer: PHP Commercial |
$1,787.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,829.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,463.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,850.25
|
| Rate for Payer: UHC Core |
$1,755.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,576.92
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
OP
|
$2,102.56
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$370.68 |
| Max. Negotiated Rate |
$1,892.30 |
| Rate for Payer: Aetna Commercial |
$1,787.18
|
| Rate for Payer: Aetna Medicare |
$546.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$657.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$657.05
|
| Rate for Payer: BCBS Complete |
$389.18
|
| Rate for Payer: BCBS MAPPO |
$525.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,728.51
|
| Rate for Payer: BCN Commercial |
$1,728.51
|
| Rate for Payer: BCN Medicare Advantage |
$525.64
|
| Rate for Payer: Cash Price |
$1,682.05
|
| Rate for Payer: Cofinity Commercial |
$1,808.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,682.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$525.64
|
| Rate for Payer: Healthscope Commercial |
$1,892.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,576.92
|
| Rate for Payer: Mclaren Medicaid |
$370.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.92
|
| Rate for Payer: Meridian Medicaid |
$389.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$604.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$578.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,787.18
|
| Rate for Payer: Nomi Health Commercial |
$1,724.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.92
|
| Rate for Payer: PACE Senior Care Partners |
$499.36
|
| Rate for Payer: PACE SWMI |
$525.64
|
| Rate for Payer: PHP Commercial |
$1,787.18
|
| Rate for Payer: PHP Medicare Advantage |
$525.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,829.23
|
| Rate for Payer: Priority Health Medicare |
$530.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,463.38
|
| Rate for Payer: Railroad Medicare Medicare |
$525.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,850.25
|
| Rate for Payer: UHC Core |
$1,755.64
|
| Rate for Payer: UHC Exchange |
$525.64
|
| Rate for Payer: UHC Medicaid |
$370.68
|
| Rate for Payer: UHC Medicare Advantage |
$525.64
|
| Rate for Payer: UHCCP Medicaid |
$370.68
|
| Rate for Payer: VA VA |
$525.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,576.92
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
OP
|
$1,780.64
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$313.93 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: Aetna Medicare |
$462.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.45
|
| Rate for Payer: BCBS Complete |
$329.60
|
| Rate for Payer: BCBS MAPPO |
$445.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.86
|
| Rate for Payer: BCN Commercial |
$1,463.86
|
| Rate for Payer: BCN Medicare Advantage |
$445.16
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.16
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,335.48
|
| Rate for Payer: Mclaren Medicaid |
$313.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.42
|
| Rate for Payer: Meridian Medicaid |
$329.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Nomi Health Commercial |
$1,460.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: PACE Senior Care Partners |
$422.90
|
| Rate for Payer: PACE SWMI |
$445.16
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: PHP Medicare Advantage |
$445.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,549.16
|
| Rate for Payer: Priority Health Medicare |
$449.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,239.33
|
| Rate for Payer: Railroad Medicare Medicare |
$445.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,566.96
|
| Rate for Payer: UHC Core |
$1,486.83
|
| Rate for Payer: UHC Exchange |
$445.16
|
| Rate for Payer: UHC Medicaid |
$313.93
|
| Rate for Payer: UHC Medicare Advantage |
$445.16
|
| Rate for Payer: UHCCP Medicaid |
$313.93
|
| Rate for Payer: VA VA |
$445.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,335.48
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
IP
|
$1,780.64
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,239.33 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,470.63
|
| Rate for Payer: BCN Commercial |
$1,470.63
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,335.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Nomi Health Commercial |
$1,460.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,549.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,239.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,566.96
|
| Rate for Payer: UHC Core |
$1,486.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,335.48
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
OP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$313.93 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: Aetna Commercial |
$2,270.32
|
| Rate for Payer: Aetna Medicare |
$694.45
|
| Rate for Payer: Aetna Medicare |
$462.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$834.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$834.67
|
| Rate for Payer: BCBS Complete |
$329.60
|
| Rate for Payer: BCBS Complete |
$494.39
|
| Rate for Payer: BCBS MAPPO |
$445.16
|
| Rate for Payer: BCBS MAPPO |
$667.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,195.80
|
| Rate for Payer: BCN Commercial |
$2,195.80
|
| Rate for Payer: BCN Commercial |
$1,463.86
|
| Rate for Payer: BCN Medicare Advantage |
$667.74
|
| Rate for Payer: BCN Medicare Advantage |
$445.16
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cash Price |
$2,136.77
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Cofinity Commercial |
$2,297.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,136.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$667.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.16
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Healthscope Commercial |
$2,403.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,335.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,003.22
|
| Rate for Payer: Mclaren Medicaid |
$470.89
|
| Rate for Payer: Mclaren Medicaid |
$313.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$701.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.42
|
| Rate for Payer: Meridian Medicaid |
$329.60
|
| Rate for Payer: Meridian Medicaid |
$494.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$767.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$734.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,270.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Nomi Health Commercial |
$2,190.19
|
| Rate for Payer: Nomi Health Commercial |
$1,460.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,003.22
|
| Rate for Payer: PACE Senior Care Partners |
$634.35
|
| Rate for Payer: PACE Senior Care Partners |
$422.90
|
| Rate for Payer: PACE SWMI |
$667.74
|
| Rate for Payer: PACE SWMI |
$445.16
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: PHP Commercial |
$2,270.32
|
| Rate for Payer: PHP Medicare Advantage |
$445.16
|
| Rate for Payer: PHP Medicare Advantage |
$667.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,323.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,549.16
|
| Rate for Payer: Priority Health Medicare |
$674.42
|
| Rate for Payer: Priority Health Medicare |
$449.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,239.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,858.99
|
| Rate for Payer: Railroad Medicare Medicare |
$445.16
|
| Rate for Payer: Railroad Medicare Medicare |
$667.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,566.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,350.44
|
| Rate for Payer: UHC Core |
$2,230.25
|
| Rate for Payer: UHC Core |
$1,486.83
|
| Rate for Payer: UHC Exchange |
$667.74
|
| Rate for Payer: UHC Exchange |
$445.16
|
| Rate for Payer: UHC Medicaid |
$470.89
|
| Rate for Payer: UHC Medicaid |
$313.93
|
| Rate for Payer: UHC Medicare Advantage |
$445.16
|
| Rate for Payer: UHC Medicare Advantage |
$667.74
|
| Rate for Payer: UHCCP Medicaid |
$313.93
|
| Rate for Payer: UHCCP Medicaid |
$470.89
|
| Rate for Payer: VA VA |
$445.16
|
| Rate for Payer: VA VA |
$667.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,003.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,335.48
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
IP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,239.33 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: Aetna Commercial |
$2,270.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,470.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,205.95
|
| Rate for Payer: BCN Commercial |
$1,470.63
|
| Rate for Payer: BCN Commercial |
$2,205.95
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cash Price |
$2,136.77
|
| Rate for Payer: Cofinity Commercial |
$2,297.03
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,136.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Healthscope Commercial |
$2,403.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,335.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,003.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,270.32
|
| Rate for Payer: Nomi Health Commercial |
$1,460.12
|
| Rate for Payer: Nomi Health Commercial |
$2,190.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,003.22
|
| Rate for Payer: PHP Commercial |
$2,270.32
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,323.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,549.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,239.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,858.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,566.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,350.44
|
| Rate for Payer: UHC Core |
$1,486.83
|
| Rate for Payer: UHC Core |
$2,230.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,335.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,003.22
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
IP
|
$1,576.53
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,097.26 |
| Max. Negotiated Rate |
$1,418.88 |
| Rate for Payer: Aetna Commercial |
$1,340.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,302.06
|
| Rate for Payer: BCN Commercial |
$1,302.06
|
| Rate for Payer: Cash Price |
$1,261.22
|
| Rate for Payer: Cofinity Commercial |
$1,355.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.22
|
| Rate for Payer: Healthscope Commercial |
$1,418.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.05
|
| Rate for Payer: Nomi Health Commercial |
$1,292.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.40
|
| Rate for Payer: PHP Commercial |
$1,340.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,371.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,097.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,387.35
|
| Rate for Payer: UHC Core |
$1,316.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.40
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
OP
|
$1,576.53
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$277.94 |
| Max. Negotiated Rate |
$1,418.88 |
| Rate for Payer: Aetna Commercial |
$1,340.05
|
| Rate for Payer: Aetna Medicare |
$409.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.67
|
| Rate for Payer: BCBS Complete |
$291.82
|
| Rate for Payer: BCBS MAPPO |
$394.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.07
|
| Rate for Payer: BCN Commercial |
$1,296.07
|
| Rate for Payer: BCN Medicare Advantage |
$394.13
|
| Rate for Payer: Cash Price |
$1,261.22
|
| Rate for Payer: Cofinity Commercial |
$1,355.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.13
|
| Rate for Payer: Healthscope Commercial |
$1,418.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.40
|
| Rate for Payer: Mclaren Medicaid |
$277.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.84
|
| Rate for Payer: Meridian Medicaid |
$291.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$453.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$433.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.05
|
| Rate for Payer: Nomi Health Commercial |
$1,292.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.40
|
| Rate for Payer: PACE Senior Care Partners |
$374.43
|
| Rate for Payer: PACE SWMI |
$394.13
|
| Rate for Payer: PHP Commercial |
$1,340.05
|
| Rate for Payer: PHP Medicare Advantage |
$394.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,371.58
|
| Rate for Payer: Priority Health Medicare |
$398.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,097.26
|
| Rate for Payer: Railroad Medicare Medicare |
$394.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,387.35
|
| Rate for Payer: UHC Core |
$1,316.40
|
| Rate for Payer: UHC Exchange |
$394.13
|
| Rate for Payer: UHC Medicaid |
$277.94
|
| Rate for Payer: UHC Medicare Advantage |
$394.13
|
| Rate for Payer: UHCCP Medicaid |
$277.94
|
| Rate for Payer: VA VA |
$394.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.40
|
|
|
HC CT LOWER EXTREM WO CON
|
Facility
|
OP
|
$1,376.45
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$242.67 |
| Max. Negotiated Rate |
$1,238.81 |
| Rate for Payer: Aetna Commercial |
$1,169.98
|
| Rate for Payer: Aetna Commercial |
$1,754.97
|
| Rate for Payer: Aetna Medicare |
$536.81
|
| Rate for Payer: Aetna Medicare |
$357.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$645.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$430.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$430.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$645.21
|
| Rate for Payer: BCBS Complete |
$254.78
|
| Rate for Payer: BCBS Complete |
$382.17
|
| Rate for Payer: BCBS MAPPO |
$344.11
|
| Rate for Payer: BCBS MAPPO |
$516.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,697.37
|
| Rate for Payer: BCN Commercial |
$1,697.37
|
| Rate for Payer: BCN Commercial |
$1,131.58
|
| Rate for Payer: BCN Medicare Advantage |
$516.17
|
| Rate for Payer: BCN Medicare Advantage |
$344.11
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cash Price |
$1,651.74
|
| Rate for Payer: Cofinity Commercial |
$1,183.75
|
| Rate for Payer: Cofinity Commercial |
$1,775.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,651.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.11
|
| Rate for Payer: Healthscope Commercial |
$1,238.81
|
| Rate for Payer: Healthscope Commercial |
$1,858.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,548.50
|
| Rate for Payer: Mclaren Medicaid |
$364.00
|
| Rate for Payer: Mclaren Medicaid |
$242.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$541.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.32
|
| Rate for Payer: Meridian Medicaid |
$254.78
|
| Rate for Payer: Meridian Medicaid |
$382.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$593.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$567.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$378.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,754.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.98
|
| Rate for Payer: Nomi Health Commercial |
$1,693.03
|
| Rate for Payer: Nomi Health Commercial |
$1,128.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,548.50
|
| Rate for Payer: PACE Senior Care Partners |
$490.36
|
| Rate for Payer: PACE Senior Care Partners |
$326.91
|
| Rate for Payer: PACE SWMI |
$516.17
|
| Rate for Payer: PACE SWMI |
$344.11
|
| Rate for Payer: PHP Commercial |
$1,169.98
|
| Rate for Payer: PHP Commercial |
$1,754.97
|
| Rate for Payer: PHP Medicare Advantage |
$344.11
|
| Rate for Payer: PHP Medicare Advantage |
$516.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$364.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,796.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,197.51
|
| Rate for Payer: Priority Health Medicare |
$521.33
|
| Rate for Payer: Priority Health Medicare |
$347.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$958.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,437.01
|
| Rate for Payer: Railroad Medicare Medicare |
$344.11
|
| Rate for Payer: Railroad Medicare Medicare |
$516.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,816.91
|
| Rate for Payer: UHC Core |
$1,724.00
|
| Rate for Payer: UHC Core |
$1,149.34
|
| Rate for Payer: UHC Exchange |
$516.17
|
| Rate for Payer: UHC Exchange |
$344.11
|
| Rate for Payer: UHC Medicaid |
$364.00
|
| Rate for Payer: UHC Medicaid |
$242.67
|
| Rate for Payer: UHC Medicare Advantage |
$344.11
|
| Rate for Payer: UHC Medicare Advantage |
$516.17
|
| Rate for Payer: UHCCP Medicaid |
$242.67
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: VA VA |
$344.11
|
| Rate for Payer: VA VA |
$516.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,548.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.34
|
|
