|
HC CT CHEST SCREENING LUNG CANCER
|
Facility
|
OP
|
$505.03
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$454.53 |
| Rate for Payer: Aetna Commercial |
$429.28
|
| Rate for Payer: Aetna Medicare |
$131.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.82
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS MAPPO |
$126.26
|
| Rate for Payer: BCBS Trust/PPO |
$415.19
|
| Rate for Payer: BCN Commercial |
$392.66
|
| Rate for Payer: BCN Medicare Advantage |
$126.26
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cofinity Commercial |
$434.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$454.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.77
|
| Rate for Payer: Mclaren Medicaid |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.57
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.28
|
| Rate for Payer: Nomi Health Commercial |
$414.12
|
| Rate for Payer: PACE Senior Care Partners |
$119.94
|
| Rate for Payer: PACE SWMI |
$126.26
|
| Rate for Payer: PHP Commercial |
$429.28
|
| Rate for Payer: PHP Medicare Advantage |
$126.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.27
|
| Rate for Payer: Priority Health HMO/PPO |
$439.38
|
| Rate for Payer: Priority Health Medicare |
$127.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.37
|
| Rate for Payer: Railroad Medicare Medicare |
$126.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.43
|
| Rate for Payer: UHC Core |
$421.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.26
|
| Rate for Payer: UHC Exchange |
$126.26
|
| Rate for Payer: UHC Medicare Advantage |
$126.26
|
| Rate for Payer: UHCCP Medicaid |
$75.33
|
| Rate for Payer: VA VA |
$126.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.77
|
|
|
HC CT CHEST WITH CON
|
Facility
|
OP
|
$1,737.15
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$1,563.44 |
| Rate for Payer: Aetna Commercial |
$1,476.58
|
| Rate for Payer: Aetna Medicare |
$451.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$542.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$542.86
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$434.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,428.11
|
| Rate for Payer: BCN Commercial |
$1,350.63
|
| Rate for Payer: BCN Medicare Advantage |
$434.29
|
| Rate for Payer: Cash Price |
$1,389.72
|
| Rate for Payer: Cash Price |
$1,389.72
|
| Rate for Payer: Cofinity Commercial |
$1,493.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,389.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.29
|
| Rate for Payer: Healthscope Commercial |
$1,563.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,302.86
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.00
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$499.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.58
|
| Rate for Payer: Nomi Health Commercial |
$1,424.46
|
| Rate for Payer: PACE Senior Care Partners |
$412.57
|
| Rate for Payer: PACE SWMI |
$434.29
|
| Rate for Payer: PHP Commercial |
$1,476.58
|
| Rate for Payer: PHP Medicare Advantage |
$434.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,511.32
|
| Rate for Payer: Priority Health Medicare |
$438.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,163.89
|
| Rate for Payer: Railroad Medicare Medicare |
$434.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,528.69
|
| Rate for Payer: UHC Core |
$1,450.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.29
|
| Rate for Payer: UHC Exchange |
$434.29
|
| Rate for Payer: UHC Medicare Advantage |
$434.29
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$434.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,302.86
|
|
|
HC CT CHEST WITH CON
|
Facility
|
IP
|
$1,737.15
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,129.15 |
| Max. Negotiated Rate |
$1,563.44 |
| Rate for Payer: Aetna Commercial |
$1,476.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,418.04
|
| Rate for Payer: BCN Commercial |
$1,342.47
|
| Rate for Payer: Cash Price |
$1,389.72
|
| Rate for Payer: Cofinity Commercial |
$1,493.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,389.72
|
| Rate for Payer: Healthscope Commercial |
$1,563.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,302.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.58
|
| Rate for Payer: Nomi Health Commercial |
$1,424.46
|
| Rate for Payer: PHP Commercial |
$1,476.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,511.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,163.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,528.69
|
| Rate for Payer: UHC Core |
$1,450.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,302.86
|
|
|
HC CT CHEST WO CON
|
Facility
|
OP
|
$1,514.09
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$1,362.68 |
| Rate for Payer: Aetna Commercial |
$1,286.98
|
| Rate for Payer: Aetna Medicare |
$393.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$473.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$473.15
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS MAPPO |
$378.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,244.73
|
| Rate for Payer: BCN Commercial |
$1,177.20
|
| Rate for Payer: BCN Medicare Advantage |
$378.52
|
| Rate for Payer: Cash Price |
$1,211.27
|
| Rate for Payer: Cash Price |
$1,211.27
|
| Rate for Payer: Cofinity Commercial |
$1,302.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,211.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.52
|
| Rate for Payer: Healthscope Commercial |
$1,362.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,135.57
|
| Rate for Payer: Mclaren Medicaid |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.45
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$435.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,286.98
|
| Rate for Payer: Nomi Health Commercial |
$1,241.55
|
| Rate for Payer: PACE Senior Care Partners |
$359.60
|
| Rate for Payer: PACE SWMI |
$378.52
|
| Rate for Payer: PHP Commercial |
$1,286.98
|
| Rate for Payer: PHP Medicare Advantage |
$378.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.16
|
| Rate for Payer: Priority Health HMO/PPO |
$1,317.26
|
| Rate for Payer: Priority Health Medicare |
$382.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,014.44
|
| Rate for Payer: Railroad Medicare Medicare |
$378.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,332.40
|
| Rate for Payer: UHC Core |
$1,264.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.52
|
| Rate for Payer: UHC Exchange |
$378.52
|
| Rate for Payer: UHC Medicare Advantage |
$378.52
|
| Rate for Payer: UHCCP Medicaid |
$75.33
|
| Rate for Payer: VA VA |
$378.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,135.57
|
|
|
HC CT CHEST WO CON
|
Facility
|
IP
|
$1,514.09
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$984.16 |
| Max. Negotiated Rate |
$1,362.68 |
| Rate for Payer: Aetna Commercial |
$1,286.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,235.95
|
| Rate for Payer: BCN Commercial |
$1,170.09
|
| Rate for Payer: Cash Price |
$1,211.27
|
| Rate for Payer: Cofinity Commercial |
$1,302.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,211.27
|
| Rate for Payer: Healthscope Commercial |
$1,362.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,135.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,286.98
|
| Rate for Payer: Nomi Health Commercial |
$1,241.55
|
| Rate for Payer: PHP Commercial |
$1,286.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.16
|
| Rate for Payer: Priority Health HMO/PPO |
$1,317.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,014.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,332.40
|
| Rate for Payer: UHC Core |
$1,264.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,135.57
|
|
|
HC CT CHEST WO W CON
|
Facility
|
IP
|
$2,055.93
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
35200002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,336.35 |
| Max. Negotiated Rate |
$1,850.34 |
| Rate for Payer: Aetna Commercial |
$1,747.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,678.26
|
| Rate for Payer: BCN Commercial |
$1,588.82
|
| Rate for Payer: Cash Price |
$1,644.74
|
| Rate for Payer: Cofinity Commercial |
$1,768.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,644.74
|
| Rate for Payer: Healthscope Commercial |
$1,850.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,541.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,747.54
|
| Rate for Payer: Nomi Health Commercial |
$1,685.86
|
| Rate for Payer: PHP Commercial |
$1,747.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,788.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,377.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,809.22
|
| Rate for Payer: UHC Core |
$1,716.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,541.95
|
|
|
HC CT CHEST WO W CON
|
Facility
|
OP
|
$2,055.93
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
35200002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$1,850.34 |
| Rate for Payer: Aetna Commercial |
$1,747.54
|
| Rate for Payer: Aetna Medicare |
$534.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$642.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$642.48
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$513.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,690.18
|
| Rate for Payer: BCN Commercial |
$1,598.49
|
| Rate for Payer: BCN Medicare Advantage |
$513.98
|
| Rate for Payer: Cash Price |
$1,644.74
|
| Rate for Payer: Cash Price |
$1,644.74
|
| Rate for Payer: Cofinity Commercial |
$1,768.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,644.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$513.98
|
| Rate for Payer: Healthscope Commercial |
$1,850.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,541.95
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$539.68
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$591.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,747.54
|
| Rate for Payer: Nomi Health Commercial |
$1,685.86
|
| Rate for Payer: PACE Senior Care Partners |
$488.28
|
| Rate for Payer: PACE SWMI |
$513.98
|
| Rate for Payer: PHP Commercial |
$1,747.54
|
| Rate for Payer: PHP Medicare Advantage |
$513.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,788.66
|
| Rate for Payer: Priority Health Medicare |
$519.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,377.47
|
| Rate for Payer: Railroad Medicare Medicare |
$513.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,809.22
|
| Rate for Payer: UHC Core |
$1,716.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$513.98
|
| Rate for Payer: UHC Exchange |
$513.98
|
| Rate for Payer: UHC Medicare Advantage |
$513.98
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$513.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,541.95
|
|
|
HC CT CORONARY ANGIO
|
Facility
|
OP
|
$1,380.41
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$252.98 |
| 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 |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$345.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.84
|
| Rate for Payer: BCN Commercial |
$1,073.27
|
| Rate for Payer: BCN Medicare Advantage |
$345.10
|
| Rate for Payer: Cash Price |
$1,104.33
|
| 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 |
$252.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.36
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.35
|
| Rate for Payer: Nomi Health Commercial |
$1,131.94
|
| 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 |
$252.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.27
|
| Rate for Payer: Priority Health HMO/PPO |
$1,200.96
|
| Rate for Payer: Priority Health Medicare |
$348.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$924.87
|
| 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 Dual Complete DSNP |
$345.10
|
| Rate for Payer: UHC Exchange |
$345.10
|
| Rate for Payer: UHC Medicare Advantage |
$345.10
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: VA VA |
$345.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.31
|
|
|
HC CT CORONARY ANGIO
|
Facility
|
IP
|
$1,380.41
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$897.27 |
| Max. Negotiated Rate |
$1,242.37 |
| Rate for Payer: Aetna Commercial |
$1,173.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.83
|
| Rate for Payer: BCN Commercial |
$1,066.78
|
| 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: PHP Commercial |
$1,173.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.27
|
| Rate for Payer: Priority Health HMO/PPO |
$1,200.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$924.87
|
| 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 CRYOABLATION GUIDANCE
|
Facility
|
OP
|
$1,096.58
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$260.44 |
| Max. Negotiated Rate |
$986.92 |
| Rate for Payer: Aetna Commercial |
$932.09
|
| Rate for Payer: Aetna Medicare |
$285.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$342.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$342.68
|
| Rate for Payer: BCBS Complete |
$438.63
|
| Rate for Payer: BCBS MAPPO |
$274.14
|
| Rate for Payer: BCBS Trust/PPO |
$901.50
|
| Rate for Payer: BCN Commercial |
$852.59
|
| Rate for Payer: BCN Medicare Advantage |
$274.14
|
| Rate for Payer: Cash Price |
$877.26
|
| Rate for Payer: Cofinity Commercial |
$943.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.14
|
| Rate for Payer: Healthscope Commercial |
$986.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$822.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$932.09
|
| Rate for Payer: Nomi Health Commercial |
$899.20
|
| Rate for Payer: PACE Senior Care Partners |
$260.44
|
| Rate for Payer: PACE SWMI |
$274.14
|
| Rate for Payer: PHP Commercial |
$932.09
|
| Rate for Payer: PHP Medicare Advantage |
$274.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$712.78
|
| Rate for Payer: Priority Health HMO/PPO |
$954.02
|
| Rate for Payer: Priority Health Medicare |
$276.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$734.71
|
| Rate for Payer: Railroad Medicare Medicare |
$274.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$964.99
|
| Rate for Payer: UHC Core |
$915.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$274.14
|
| Rate for Payer: UHC Exchange |
$274.14
|
| Rate for Payer: UHC Medicare Advantage |
$274.14
|
| Rate for Payer: VA VA |
$274.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$822.44
|
|
|
HC CT CRYOABLATION GUIDANCE
|
Facility
|
IP
|
$1,096.58
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$712.78 |
| Max. Negotiated Rate |
$986.92 |
| Rate for Payer: Aetna Commercial |
$932.09
|
| Rate for Payer: BCBS Trust/PPO |
$895.14
|
| Rate for Payer: BCN Commercial |
$847.44
|
| Rate for Payer: Cash Price |
$877.26
|
| Rate for Payer: Cofinity Commercial |
$943.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.26
|
| Rate for Payer: Healthscope Commercial |
$986.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$822.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$932.09
|
| Rate for Payer: Nomi Health Commercial |
$899.20
|
| Rate for Payer: PHP Commercial |
$932.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$712.78
|
| Rate for Payer: Priority Health HMO/PPO |
$954.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$734.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$964.99
|
| Rate for Payer: UHC Core |
$915.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$822.44
|
|
|
HC CT FACIAL W CON
|
Facility
|
IP
|
$1,591.71
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
35100008
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,034.61 |
| Max. Negotiated Rate |
$1,432.54 |
| Rate for Payer: Aetna Commercial |
$1,352.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,299.31
|
| Rate for Payer: BCN Commercial |
$1,230.07
|
| Rate for Payer: Cash Price |
$1,273.37
|
| Rate for Payer: Cofinity Commercial |
$1,368.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,273.37
|
| Rate for Payer: Healthscope Commercial |
$1,432.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,193.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,352.95
|
| Rate for Payer: Nomi Health Commercial |
$1,305.20
|
| Rate for Payer: PHP Commercial |
$1,352.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.61
|
| Rate for Payer: Priority Health HMO/PPO |
$1,384.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,066.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,400.70
|
| Rate for Payer: UHC Core |
$1,329.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,193.78
|
|
|
HC CT FACIAL W CON
|
Facility
|
OP
|
$1,591.71
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
35100008
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$1,432.54 |
| Rate for Payer: Aetna Commercial |
$1,352.95
|
| Rate for Payer: Aetna Medicare |
$413.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.41
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$397.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,308.54
|
| Rate for Payer: BCN Commercial |
$1,237.55
|
| Rate for Payer: BCN Medicare Advantage |
$397.93
|
| Rate for Payer: Cash Price |
$1,273.37
|
| Rate for Payer: Cash Price |
$1,273.37
|
| Rate for Payer: Cofinity Commercial |
$1,368.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,273.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.93
|
| Rate for Payer: Healthscope Commercial |
$1,432.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,193.78
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$417.82
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$457.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,352.95
|
| Rate for Payer: Nomi Health Commercial |
$1,305.20
|
| Rate for Payer: PACE Senior Care Partners |
$378.03
|
| Rate for Payer: PACE SWMI |
$397.93
|
| Rate for Payer: PHP Commercial |
$1,352.95
|
| Rate for Payer: PHP Medicare Advantage |
$397.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.61
|
| Rate for Payer: Priority Health HMO/PPO |
$1,384.79
|
| Rate for Payer: Priority Health Medicare |
$401.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,066.45
|
| Rate for Payer: Railroad Medicare Medicare |
$397.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,400.70
|
| Rate for Payer: UHC Core |
$1,329.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$397.93
|
| Rate for Payer: UHC Exchange |
$397.93
|
| Rate for Payer: UHC Medicare Advantage |
$397.93
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$397.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,193.78
|
|
|
HC CT FACIAL WO CON
|
Facility
|
IP
|
$1,410.88
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
35100007
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$917.07 |
| Max. Negotiated Rate |
$1,269.79 |
| Rate for Payer: Aetna Commercial |
$1,199.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,151.70
|
| Rate for Payer: BCN Commercial |
$1,090.33
|
| Rate for Payer: Cash Price |
$1,128.70
|
| Rate for Payer: Cofinity Commercial |
$1,213.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.70
|
| Rate for Payer: Healthscope Commercial |
$1,269.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,058.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,199.25
|
| Rate for Payer: Nomi Health Commercial |
$1,156.92
|
| Rate for Payer: PHP Commercial |
$1,199.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,227.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$945.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,241.57
|
| Rate for Payer: UHC Core |
$1,178.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,058.16
|
|
|
HC CT FACIAL WO CON
|
Facility
|
OP
|
$1,410.88
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
35100007
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$1,269.79 |
| Rate for Payer: Aetna Commercial |
$1,199.25
|
| Rate for Payer: Aetna Medicare |
$366.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.90
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS MAPPO |
$352.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.88
|
| Rate for Payer: BCN Commercial |
$1,096.96
|
| Rate for Payer: BCN Medicare Advantage |
$352.72
|
| Rate for Payer: Cash Price |
$1,128.70
|
| Rate for Payer: Cash Price |
$1,128.70
|
| Rate for Payer: Cofinity Commercial |
$1,213.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.72
|
| Rate for Payer: Healthscope Commercial |
$1,269.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,058.16
|
| Rate for Payer: Mclaren Medicaid |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.36
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,199.25
|
| Rate for Payer: Nomi Health Commercial |
$1,156.92
|
| Rate for Payer: PACE Senior Care Partners |
$335.08
|
| Rate for Payer: PACE SWMI |
$352.72
|
| Rate for Payer: PHP Commercial |
$1,199.25
|
| Rate for Payer: PHP Medicare Advantage |
$352.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,227.47
|
| Rate for Payer: Priority Health Medicare |
$356.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$945.29
|
| Rate for Payer: Railroad Medicare Medicare |
$352.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,241.57
|
| Rate for Payer: UHC Core |
$1,178.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.72
|
| Rate for Payer: UHC Exchange |
$352.72
|
| Rate for Payer: UHC Medicare Advantage |
$352.72
|
| Rate for Payer: UHCCP Medicaid |
$75.33
|
| Rate for Payer: VA VA |
$352.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,058.16
|
|
|
HC CT FACIAL WO W CON
|
Facility
|
OP
|
$1,498.69
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
35101009
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$1,348.82 |
| Rate for Payer: Aetna Commercial |
$1,273.89
|
| Rate for Payer: Aetna Medicare |
$389.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$468.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$468.34
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$374.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.07
|
| Rate for Payer: BCN Commercial |
$1,165.23
|
| Rate for Payer: BCN Medicare Advantage |
$374.67
|
| Rate for Payer: Cash Price |
$1,198.95
|
| Rate for Payer: Cash Price |
$1,198.95
|
| Rate for Payer: Cofinity Commercial |
$1,288.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$374.67
|
| Rate for Payer: Healthscope Commercial |
$1,348.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,124.02
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.41
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$430.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.89
|
| Rate for Payer: Nomi Health Commercial |
$1,228.93
|
| Rate for Payer: PACE Senior Care Partners |
$355.94
|
| Rate for Payer: PACE SWMI |
$374.67
|
| Rate for Payer: PHP Commercial |
$1,273.89
|
| Rate for Payer: PHP Medicare Advantage |
$374.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,303.86
|
| Rate for Payer: Priority Health Medicare |
$378.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,004.12
|
| Rate for Payer: Railroad Medicare Medicare |
$374.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,318.85
|
| Rate for Payer: UHC Core |
$1,251.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$374.67
|
| Rate for Payer: UHC Exchange |
$374.67
|
| Rate for Payer: UHC Medicare Advantage |
$374.67
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$374.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,124.02
|
|
|
HC CT FACIAL WO W CON
|
Facility
|
IP
|
$1,498.69
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
35101009
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$974.15 |
| Max. Negotiated Rate |
$1,348.82 |
| Rate for Payer: Aetna Commercial |
$1,273.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,223.38
|
| Rate for Payer: BCN Commercial |
$1,158.19
|
| Rate for Payer: Cash Price |
$1,198.95
|
| Rate for Payer: Cofinity Commercial |
$1,288.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.95
|
| Rate for Payer: Healthscope Commercial |
$1,348.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,124.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.89
|
| Rate for Payer: Nomi Health Commercial |
$1,228.93
|
| Rate for Payer: PHP Commercial |
$1,273.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,303.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,004.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,318.85
|
| Rate for Payer: UHC Core |
$1,251.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,124.02
|
|
|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
IP
|
$1,448.55
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$941.56 |
| Max. Negotiated Rate |
$1,303.70 |
| Rate for Payer: Aetna Commercial |
$1,231.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.45
|
| Rate for Payer: BCN Commercial |
$1,119.44
|
| Rate for Payer: Cash Price |
$1,158.84
|
| Rate for Payer: Cofinity Commercial |
$1,245.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.84
|
| Rate for Payer: Healthscope Commercial |
$1,303.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.27
|
| Rate for Payer: Nomi Health Commercial |
$1,187.81
|
| Rate for Payer: PHP Commercial |
$1,231.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.56
|
| Rate for Payer: Priority Health HMO/PPO |
$1,260.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,274.72
|
| Rate for Payer: UHC Core |
$1,209.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.41
|
|
|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
OP
|
$1,448.55
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$344.03 |
| Max. Negotiated Rate |
$1,303.70 |
| Rate for Payer: Aetna Commercial |
$1,231.27
|
| Rate for Payer: Aetna Medicare |
$376.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$452.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$452.67
|
| Rate for Payer: BCBS Complete |
$579.42
|
| Rate for Payer: BCBS MAPPO |
$362.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,190.85
|
| Rate for Payer: BCN Commercial |
$1,126.25
|
| Rate for Payer: BCN Medicare Advantage |
$362.14
|
| Rate for Payer: Cash Price |
$1,158.84
|
| Rate for Payer: Cofinity Commercial |
$1,245.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.14
|
| Rate for Payer: Healthscope Commercial |
$1,303.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.27
|
| Rate for Payer: Nomi Health Commercial |
$1,187.81
|
| Rate for Payer: PACE Senior Care Partners |
$344.03
|
| Rate for Payer: PACE SWMI |
$362.14
|
| Rate for Payer: PHP Commercial |
$1,231.27
|
| Rate for Payer: PHP Medicare Advantage |
$362.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.56
|
| Rate for Payer: Priority Health HMO/PPO |
$1,260.24
|
| Rate for Payer: Priority Health Medicare |
$365.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.53
|
| Rate for Payer: Railroad Medicare Medicare |
$362.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,274.72
|
| Rate for Payer: UHC Core |
$1,209.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.14
|
| Rate for Payer: UHC Exchange |
$362.14
|
| Rate for Payer: UHC Medicare Advantage |
$362.14
|
| Rate for Payer: VA VA |
$362.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.41
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,310.90
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$852.08 |
| Max. Negotiated Rate |
$1,179.81 |
| Rate for Payer: Aetna Commercial |
$1,114.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,070.09
|
| Rate for Payer: BCN Commercial |
$1,013.06
|
| Rate for Payer: Cash Price |
$1,048.72
|
| Rate for Payer: Cofinity Commercial |
$1,127.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.72
|
| Rate for Payer: Healthscope Commercial |
$1,179.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$983.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,114.26
|
| Rate for Payer: Nomi Health Commercial |
$1,074.94
|
| Rate for Payer: PHP Commercial |
$1,114.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.08
|
| Rate for Payer: Priority Health HMO/PPO |
$1,140.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$878.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,153.59
|
| Rate for Payer: UHC Core |
$1,094.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$983.18
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,310.90
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$311.34 |
| Max. Negotiated Rate |
$1,179.81 |
| Rate for Payer: Aetna Commercial |
$1,114.26
|
| Rate for Payer: Aetna Medicare |
$340.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$409.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$409.66
|
| Rate for Payer: BCBS Complete |
$524.36
|
| Rate for Payer: BCBS MAPPO |
$327.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.69
|
| Rate for Payer: BCN Commercial |
$1,019.22
|
| Rate for Payer: BCN Medicare Advantage |
$327.72
|
| Rate for Payer: Cash Price |
$1,048.72
|
| Rate for Payer: Cofinity Commercial |
$1,127.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.72
|
| Rate for Payer: Healthscope Commercial |
$1,179.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$983.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,114.26
|
| Rate for Payer: Nomi Health Commercial |
$1,074.94
|
| Rate for Payer: PACE Senior Care Partners |
$311.34
|
| Rate for Payer: PACE SWMI |
$327.72
|
| Rate for Payer: PHP Commercial |
$1,114.26
|
| Rate for Payer: PHP Medicare Advantage |
$327.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.08
|
| Rate for Payer: Priority Health HMO/PPO |
$1,140.48
|
| Rate for Payer: Priority Health Medicare |
$331.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$878.30
|
| Rate for Payer: Railroad Medicare Medicare |
$327.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,153.59
|
| Rate for Payer: UHC Core |
$1,094.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.72
|
| Rate for Payer: UHC Exchange |
$327.72
|
| Rate for Payer: UHC Medicare Advantage |
$327.72
|
| Rate for Payer: VA VA |
$327.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$983.18
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$461.88 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: BCBS Trust/PPO |
$580.05
|
| Rate for Payer: BCN Commercial |
$549.14
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO |
$618.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.32
|
| Rate for Payer: UHC Core |
$593.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.94
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$168.77 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: Aetna Medicare |
$184.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.06
|
| Rate for Payer: BCBS Complete |
$284.24
|
| Rate for Payer: BCBS MAPPO |
$177.65
|
| Rate for Payer: BCBS Trust/PPO |
$584.18
|
| Rate for Payer: BCN Commercial |
$552.48
|
| Rate for Payer: BCN Medicare Advantage |
$177.65
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.65
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: PACE Senior Care Partners |
$168.77
|
| Rate for Payer: PACE SWMI |
$177.65
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: PHP Medicare Advantage |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO |
$618.21
|
| Rate for Payer: Priority Health Medicare |
$179.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.10
|
| Rate for Payer: Railroad Medicare Medicare |
$177.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.32
|
| Rate for Payer: UHC Core |
$593.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.65
|
| Rate for Payer: UHC Exchange |
$177.65
|
| Rate for Payer: UHC Medicare Advantage |
$177.65
|
| Rate for Payer: VA VA |
$177.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.94
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
IP
|
$1,197.50
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$778.38 |
| Max. Negotiated Rate |
$1,077.75 |
| Rate for Payer: Aetna Commercial |
$1,017.88
|
| Rate for Payer: BCBS Trust/PPO |
$977.52
|
| Rate for Payer: BCN Commercial |
$925.43
|
| Rate for Payer: Cash Price |
$958.00
|
| Rate for Payer: Cofinity Commercial |
$1,029.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$958.00
|
| Rate for Payer: Healthscope Commercial |
$1,077.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$898.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.88
|
| Rate for Payer: Nomi Health Commercial |
$981.95
|
| Rate for Payer: PHP Commercial |
$1,017.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.38
|
| Rate for Payer: Priority Health HMO/PPO |
$1,041.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,053.80
|
| Rate for Payer: UHC Core |
$999.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$898.12
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
OP
|
$1,197.50
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$284.41 |
| Max. Negotiated Rate |
$1,077.75 |
| Rate for Payer: Aetna Commercial |
$1,017.88
|
| Rate for Payer: Aetna Medicare |
$311.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$374.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$374.22
|
| Rate for Payer: BCBS Complete |
$479.00
|
| Rate for Payer: BCBS MAPPO |
$299.38
|
| Rate for Payer: BCBS Trust/PPO |
$984.46
|
| Rate for Payer: BCN Commercial |
$931.06
|
| Rate for Payer: BCN Medicare Advantage |
$299.38
|
| Rate for Payer: Cash Price |
$958.00
|
| Rate for Payer: Cofinity Commercial |
$1,029.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$958.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.38
|
| Rate for Payer: Healthscope Commercial |
$1,077.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$898.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.88
|
| Rate for Payer: Nomi Health Commercial |
$981.95
|
| Rate for Payer: PACE Senior Care Partners |
$284.41
|
| Rate for Payer: PACE SWMI |
$299.38
|
| Rate for Payer: PHP Commercial |
$1,017.88
|
| Rate for Payer: PHP Medicare Advantage |
$299.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.38
|
| Rate for Payer: Priority Health HMO/PPO |
$1,041.82
|
| Rate for Payer: Priority Health Medicare |
$302.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.32
|
| Rate for Payer: Railroad Medicare Medicare |
$299.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,053.80
|
| Rate for Payer: UHC Core |
$999.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.38
|
| Rate for Payer: UHC Exchange |
$299.38
|
| Rate for Payer: UHC Medicare Advantage |
$299.38
|
| Rate for Payer: VA VA |
$299.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$898.12
|
|
