|
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 |
$822.43
|
| 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 |
$822.43
|
|
|
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 |
$822.43
|
| 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 |
$822.43
|
|
|
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 |
$128.71 |
| 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 |
$135.15
|
| 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 |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$417.82
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| 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 |
$128.71
|
| 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 |
$128.71
|
| Rate for Payer: VA VA |
$397.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,193.78
|
|
|
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 WO CON
|
Facility
|
OP
|
$1,410.88
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
35100007
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$76.88 |
| 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 |
$80.73
|
| 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 |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.36
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| 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 |
$76.88
|
| 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 |
$76.88
|
| Rate for Payer: VA VA |
$352.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,058.16
|
|
|
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 W CON
|
Facility
|
OP
|
$1,498.69
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
35101009
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$128.71 |
| 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 |
$135.15
|
| 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 |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.41
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| 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 |
$128.71
|
| 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 |
$128.71
|
| 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
|
OP
|
$1,448.55
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$344.03 |
| Max. Negotiated Rate |
$1,303.69 |
| 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 |
$1,303.69
|
| 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 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 |
$1,303.69 |
| 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 |
$1,303.69
|
| 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 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 |
$1,114.27
|
| 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 |
$327.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.69
|
| Rate for Payer: BCN Commercial |
$1,019.22
|
| Rate for Payer: BCN Medicare Advantage |
$327.73
|
| 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 |
$327.73
|
| Rate for Payer: Healthscope Commercial |
$1,179.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$983.17
|
| 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 |
$1,114.27
|
| Rate for Payer: Nomi Health Commercial |
$1,074.94
|
| Rate for Payer: PACE Senior Care Partners |
$311.34
|
| Rate for Payer: PACE SWMI |
$327.73
|
| Rate for Payer: PHP Commercial |
$1,114.27
|
| Rate for Payer: PHP Medicare Advantage |
$327.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.09
|
| 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 |
$327.73
|
| 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 |
$327.73
|
| Rate for Payer: UHC Exchange |
$327.73
|
| Rate for Payer: UHC Medicare Advantage |
$327.73
|
| Rate for Payer: VA VA |
$327.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$983.17
|
|
|
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 |
$852.09 |
| Max. Negotiated Rate |
$1,179.81 |
| Rate for Payer: Aetna Commercial |
$1,114.27
|
| 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 |
$983.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,114.27
|
| Rate for Payer: Nomi Health Commercial |
$1,074.94
|
| Rate for Payer: PHP Commercial |
$1,114.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.09
|
| 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 |
$983.17
|
|
|
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 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 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 |
$1,041.83
|
| Rate for Payer: Priority Health Medicare |
$302.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.33
|
| 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
|
|
|
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 |
$1,041.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.33
|
| 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 HEAD ANGIO
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$710.07 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: BCBS Trust/PPO |
$891.74
|
| Rate for Payer: BCN Commercial |
$844.22
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health HMO/PPO |
$950.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$731.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$961.33
|
| Rate for Payer: UHC Core |
$912.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC CT HEAD ANGIO
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$284.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$341.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$341.38
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$273.11
|
| Rate for Payer: BCBS Trust/PPO |
$898.08
|
| Rate for Payer: BCN Commercial |
$849.36
|
| Rate for Payer: BCN Medicare Advantage |
$273.11
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.11
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.76
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$314.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: PACE Senior Care Partners |
$259.45
|
| Rate for Payer: PACE SWMI |
$273.11
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: PHP Medicare Advantage |
$273.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health HMO/PPO |
$950.41
|
| Rate for Payer: Priority Health Medicare |
$275.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$731.92
|
| Rate for Payer: Railroad Medicare Medicare |
$273.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$961.33
|
| Rate for Payer: UHC Core |
$912.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.11
|
| Rate for Payer: UHC Exchange |
$273.11
|
| Rate for Payer: UHC Medicare Advantage |
$273.11
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$273.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC CT HEART SCAN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$163.26
|
| Rate for Payer: BCN Commercial |
$154.56
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
HC CT HEART SCAN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.50
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$164.42
|
| Rate for Payer: BCN Commercial |
$155.50
|
| Rate for Payer: BCN Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.50
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| 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 |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Medicare |
$50.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.00
|
| Rate for Payer: Railroad Medicare Medicare |
$50.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.00
|
| Rate for Payer: UHC Exchange |
$50.00
|
| Rate for Payer: UHC Medicare Advantage |
$50.00
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| 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
|
$1,353.34
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$258.20 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Medicare |
$351.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.92
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$338.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,112.58
|
| Rate for Payer: BCN Commercial |
$1,052.22
|
| Rate for Payer: BCN Medicare Advantage |
$338.33
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.33
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.00
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.25
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$389.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: PACE Senior Care Partners |
$321.42
|
| Rate for Payer: PACE SWMI |
$338.33
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: PHP Medicare Advantage |
$338.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.67
|
| Rate for Payer: Priority Health HMO/PPO |
$1,177.41
|
| Rate for Payer: Priority Health Medicare |
$341.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$906.74
|
| Rate for Payer: Railroad Medicare Medicare |
$338.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.94
|
| Rate for Payer: UHC Core |
$1,130.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.33
|
| Rate for Payer: UHC Exchange |
$338.33
|
| Rate for Payer: UHC Medicare Advantage |
$338.33
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$338.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.00
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$879.67 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.73
|
| Rate for Payer: BCN Commercial |
$1,045.86
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.67
|
| Rate for Payer: Priority Health HMO/PPO |
$1,177.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$906.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.94
|
| Rate for Payer: UHC Core |
$1,130.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.00
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
OP
|
$1,380.41
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$258.20 |
| 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 |
$271.13
|
| 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 |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.36
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| 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 |
$258.20
|
| 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 |
$258.20
|
| Rate for Payer: VA VA |
$345.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.31
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
IP
|
$1,380.41
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
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 LIMITED OR FOLLOW-UP
|
Facility
|
OP
|
$705.49
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$634.94 |
| Rate for Payer: Aetna Commercial |
$599.67
|
| Rate for Payer: Aetna Medicare |
$183.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.47
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$176.37
|
| Rate for Payer: BCBS Trust/PPO |
$579.98
|
| Rate for Payer: BCN Commercial |
$548.52
|
| Rate for Payer: BCN Medicare Advantage |
$176.37
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cofinity Commercial |
$606.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.37
|
| Rate for Payer: Healthscope Commercial |
$634.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.12
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.19
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.67
|
| Rate for Payer: Nomi Health Commercial |
$578.50
|
| Rate for Payer: PACE Senior Care Partners |
$167.55
|
| Rate for Payer: PACE SWMI |
$176.37
|
| Rate for Payer: PHP Commercial |
$599.67
|
| Rate for Payer: PHP Medicare Advantage |
$176.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.57
|
| Rate for Payer: Priority Health HMO/PPO |
$613.78
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$472.68
|
| Rate for Payer: Railroad Medicare Medicare |
$176.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.83
|
| Rate for Payer: UHC Core |
$589.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.37
|
| Rate for Payer: UHC Exchange |
$176.37
|
| Rate for Payer: UHC Medicare Advantage |
$176.37
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$176.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.12
|
|
