|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
IP
|
$705.49
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$458.57 |
| Max. Negotiated Rate |
$634.94 |
| Rate for Payer: Aetna Commercial |
$599.67
|
| Rate for Payer: BCBS Trust/PPO |
$575.89
|
| Rate for Payer: BCN Commercial |
$545.20
|
| 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: Healthscope Commercial |
$634.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.67
|
| Rate for Payer: Nomi Health Commercial |
$578.50
|
| Rate for Payer: PHP Commercial |
$599.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.57
|
| Rate for Payer: Priority Health HMO/PPO |
$613.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$472.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.83
|
| Rate for Payer: UHC Core |
$589.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.12
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
IP
|
$1,904.14
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,237.69 |
| Max. Negotiated Rate |
$1,713.73 |
| Rate for Payer: Aetna Commercial |
$1,618.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,554.35
|
| Rate for Payer: BCN Commercial |
$1,471.52
|
| Rate for Payer: Cash Price |
$1,523.31
|
| Rate for Payer: Cofinity Commercial |
$1,637.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.31
|
| Rate for Payer: Healthscope Commercial |
$1,713.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,428.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,618.52
|
| Rate for Payer: Nomi Health Commercial |
$1,561.39
|
| Rate for Payer: PHP Commercial |
$1,618.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,237.69
|
| Rate for Payer: Priority Health HMO/PPO |
$1,656.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,275.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,675.64
|
| Rate for Payer: UHC Core |
$1,589.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,428.11
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
OP
|
$1,904.14
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$1,713.73 |
| Rate for Payer: Aetna Commercial |
$1,618.52
|
| Rate for Payer: Aetna Medicare |
$495.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.04
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$476.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,565.39
|
| Rate for Payer: BCN Commercial |
$1,480.47
|
| Rate for Payer: BCN Medicare Advantage |
$476.04
|
| Rate for Payer: Cash Price |
$1,523.31
|
| Rate for Payer: Cash Price |
$1,523.31
|
| Rate for Payer: Cofinity Commercial |
$1,637.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.04
|
| Rate for Payer: Healthscope Commercial |
$1,713.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,428.11
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$499.84
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,618.52
|
| Rate for Payer: Nomi Health Commercial |
$1,561.39
|
| Rate for Payer: PACE Senior Care Partners |
$452.23
|
| Rate for Payer: PACE SWMI |
$476.04
|
| Rate for Payer: PHP Commercial |
$1,618.52
|
| Rate for Payer: PHP Medicare Advantage |
$476.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,237.69
|
| Rate for Payer: Priority Health HMO/PPO |
$1,656.60
|
| Rate for Payer: Priority Health Medicare |
$480.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,275.77
|
| Rate for Payer: Railroad Medicare Medicare |
$476.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,675.64
|
| Rate for Payer: UHC Core |
$1,589.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.04
|
| Rate for Payer: UHC Exchange |
$476.04
|
| Rate for Payer: UHC Medicare Advantage |
$476.04
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$476.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,428.11
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
OP
|
$1,611.38
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$1,450.24 |
| Rate for Payer: Aetna Commercial |
$1,369.67
|
| Rate for Payer: Aetna Medicare |
$418.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$503.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$503.56
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$402.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.72
|
| Rate for Payer: BCN Commercial |
$1,252.85
|
| Rate for Payer: BCN Medicare Advantage |
$402.85
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cofinity Commercial |
$1,385.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,289.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.85
|
| Rate for Payer: Healthscope Commercial |
$1,450.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,208.54
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$422.99
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$463.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,369.67
|
| Rate for Payer: Nomi Health Commercial |
$1,321.33
|
| Rate for Payer: PACE Senior Care Partners |
$382.70
|
| Rate for Payer: PACE SWMI |
$402.85
|
| Rate for Payer: PHP Commercial |
$1,369.67
|
| Rate for Payer: PHP Medicare Advantage |
$402.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,401.90
|
| Rate for Payer: Priority Health Medicare |
$406.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,079.62
|
| Rate for Payer: Railroad Medicare Medicare |
$402.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,418.01
|
| Rate for Payer: UHC Core |
$1,345.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$402.85
|
| Rate for Payer: UHC Exchange |
$402.85
|
| Rate for Payer: UHC Medicare Advantage |
$402.85
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$402.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,208.54
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
IP
|
$1,611.38
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,047.40 |
| Max. Negotiated Rate |
$1,450.24 |
| Rate for Payer: Aetna Commercial |
$1,369.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,315.37
|
| Rate for Payer: BCN Commercial |
$1,245.27
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cofinity Commercial |
$1,385.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,289.10
|
| Rate for Payer: Healthscope Commercial |
$1,450.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,208.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,369.67
|
| Rate for Payer: Nomi Health Commercial |
$1,321.33
|
| Rate for Payer: PHP Commercial |
$1,369.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,401.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,079.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,418.01
|
| Rate for Payer: UHC Core |
$1,345.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,208.54
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
IP
|
$1,376.45
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$894.69 |
| Max. Negotiated Rate |
$1,238.81 |
| Rate for Payer: Aetna Commercial |
$1,169.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,123.60
|
| Rate for Payer: BCN Commercial |
$1,063.72
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cofinity Commercial |
$1,183.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.16
|
| Rate for Payer: Healthscope Commercial |
$1,238.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.98
|
| Rate for Payer: Nomi Health Commercial |
$1,128.69
|
| Rate for Payer: PHP Commercial |
$1,169.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.69
|
| Rate for Payer: Priority Health HMO/PPO |
$1,197.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$922.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.28
|
| Rate for Payer: UHC Core |
$1,149.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.34
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
OP
|
$1,376.45
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$1,238.81 |
| Rate for Payer: Aetna Commercial |
$1,169.98
|
| Rate for Payer: Aetna Medicare |
$357.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$430.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$430.14
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$344.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.58
|
| Rate for Payer: BCN Commercial |
$1,070.19
|
| Rate for Payer: BCN Medicare Advantage |
$344.11
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cofinity Commercial |
$1,183.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.11
|
| Rate for Payer: Healthscope Commercial |
$1,238.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.34
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.32
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.98
|
| Rate for Payer: Nomi Health Commercial |
$1,128.69
|
| Rate for Payer: PACE Senior Care Partners |
$326.91
|
| Rate for Payer: PACE SWMI |
$344.11
|
| Rate for Payer: PHP Commercial |
$1,169.98
|
| Rate for Payer: PHP Medicare Advantage |
$344.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.69
|
| Rate for Payer: Priority Health HMO/PPO |
$1,197.51
|
| Rate for Payer: Priority Health Medicare |
$347.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$922.22
|
| Rate for Payer: Railroad Medicare Medicare |
$344.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.28
|
| Rate for Payer: UHC Core |
$1,149.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$344.11
|
| Rate for Payer: UHC Exchange |
$344.11
|
| Rate for Payer: UHC Medicare Advantage |
$344.11
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$344.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.34
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
OP
|
$1,745.73
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$1,571.16 |
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: Aetna Medicare |
$453.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$545.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$545.54
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$436.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,435.16
|
| Rate for Payer: BCN Commercial |
$1,357.31
|
| Rate for Payer: BCN Medicare Advantage |
$436.43
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.43
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,309.30
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.25
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$501.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,483.87
|
| Rate for Payer: Nomi Health Commercial |
$1,431.50
|
| Rate for Payer: PACE Senior Care Partners |
$414.61
|
| Rate for Payer: PACE SWMI |
$436.43
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: PHP Medicare Advantage |
$436.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,518.79
|
| Rate for Payer: Priority Health Medicare |
$440.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,169.64
|
| Rate for Payer: Railroad Medicare Medicare |
$436.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,536.24
|
| Rate for Payer: UHC Core |
$1,457.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.43
|
| Rate for Payer: UHC Exchange |
$436.43
|
| Rate for Payer: UHC Medicare Advantage |
$436.43
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$436.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,309.30
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
IP
|
$1,745.73
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,134.72 |
| Max. Negotiated Rate |
$1,571.16 |
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,425.04
|
| Rate for Payer: BCN Commercial |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,309.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,483.87
|
| Rate for Payer: Nomi Health Commercial |
$1,431.50
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,518.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,169.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,536.24
|
| Rate for Payer: UHC Core |
$1,457.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,309.30
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
OP
|
$2,061.33
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$1,855.20 |
| Rate for Payer: Aetna Commercial |
$1,752.13
|
| Rate for Payer: Aetna Medicare |
$535.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$644.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$644.17
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$515.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,694.62
|
| Rate for Payer: BCN Commercial |
$1,602.68
|
| Rate for Payer: BCN Medicare Advantage |
$515.33
|
| Rate for Payer: Cash Price |
$1,649.06
|
| Rate for Payer: Cash Price |
$1,649.06
|
| Rate for Payer: Cofinity Commercial |
$1,772.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,649.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$515.33
|
| Rate for Payer: Healthscope Commercial |
$1,855.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,546.00
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$541.10
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$592.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,752.13
|
| Rate for Payer: Nomi Health Commercial |
$1,690.29
|
| Rate for Payer: PACE Senior Care Partners |
$489.57
|
| Rate for Payer: PACE SWMI |
$515.33
|
| Rate for Payer: PHP Commercial |
$1,752.13
|
| Rate for Payer: PHP Medicare Advantage |
$515.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.86
|
| Rate for Payer: Priority Health HMO/PPO |
$1,793.36
|
| Rate for Payer: Priority Health Medicare |
$520.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,381.09
|
| Rate for Payer: Railroad Medicare Medicare |
$515.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,813.97
|
| Rate for Payer: UHC Core |
$1,721.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$515.33
|
| Rate for Payer: UHC Exchange |
$515.33
|
| Rate for Payer: UHC Medicare Advantage |
$515.33
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$515.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,546.00
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
IP
|
$2,061.33
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,339.86 |
| Max. Negotiated Rate |
$1,855.20 |
| Rate for Payer: Aetna Commercial |
$1,752.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,682.66
|
| Rate for Payer: BCN Commercial |
$1,593.00
|
| Rate for Payer: Cash Price |
$1,649.06
|
| Rate for Payer: Cofinity Commercial |
$1,772.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,649.06
|
| Rate for Payer: Healthscope Commercial |
$1,855.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,546.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,752.13
|
| Rate for Payer: Nomi Health Commercial |
$1,690.29
|
| Rate for Payer: PHP Commercial |
$1,752.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.86
|
| Rate for Payer: Priority Health HMO/PPO |
$1,793.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,381.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,813.97
|
| Rate for Payer: UHC Core |
$1,721.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,546.00
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
OP
|
$1,745.73
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$1,571.16 |
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: Aetna Medicare |
$453.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$545.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$545.54
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$436.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,435.16
|
| Rate for Payer: BCN Commercial |
$1,357.31
|
| Rate for Payer: BCN Medicare Advantage |
$436.43
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.43
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,309.30
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.25
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$501.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,483.87
|
| Rate for Payer: Nomi Health Commercial |
$1,431.50
|
| Rate for Payer: PACE Senior Care Partners |
$414.61
|
| Rate for Payer: PACE SWMI |
$436.43
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: PHP Medicare Advantage |
$436.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,518.79
|
| Rate for Payer: Priority Health Medicare |
$440.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,169.64
|
| Rate for Payer: Railroad Medicare Medicare |
$436.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,536.24
|
| Rate for Payer: UHC Core |
$1,457.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.43
|
| Rate for Payer: UHC Exchange |
$436.43
|
| Rate for Payer: UHC Medicare Advantage |
$436.43
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$436.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,309.30
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
IP
|
$1,745.73
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,134.72 |
| Max. Negotiated Rate |
$1,571.16 |
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,425.04
|
| Rate for Payer: BCN Commercial |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,309.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,483.87
|
| Rate for Payer: Nomi Health Commercial |
$1,431.50
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,518.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,169.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,536.24
|
| Rate for Payer: UHC Core |
$1,457.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,309.30
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
OP
|
$1,745.73
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$1,571.16 |
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: Aetna Commercial |
$2,225.80
|
| Rate for Payer: Aetna Medicare |
$453.89
|
| Rate for Payer: Aetna Medicare |
$680.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$545.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$818.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$545.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$818.31
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$654.65
|
| Rate for Payer: BCBS MAPPO |
$436.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,435.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,152.74
|
| Rate for Payer: BCN Commercial |
$1,357.31
|
| Rate for Payer: BCN Commercial |
$2,035.95
|
| Rate for Payer: BCN Medicare Advantage |
$436.43
|
| Rate for Payer: BCN Medicare Advantage |
$654.65
|
| Rate for Payer: Cash Price |
$2,094.87
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$2,094.87
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Cofinity Commercial |
$2,251.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,094.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.65
|
| Rate for Payer: Healthscope Commercial |
$2,356.73
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,309.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,963.94
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.25
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$501.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,483.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,225.80
|
| Rate for Payer: Nomi Health Commercial |
$1,431.50
|
| Rate for Payer: Nomi Health Commercial |
$2,147.24
|
| Rate for Payer: PACE Senior Care Partners |
$414.61
|
| Rate for Payer: PACE Senior Care Partners |
$621.92
|
| Rate for Payer: PACE SWMI |
$436.43
|
| Rate for Payer: PACE SWMI |
$654.65
|
| Rate for Payer: PHP Commercial |
$2,225.80
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: PHP Medicare Advantage |
$436.43
|
| Rate for Payer: PHP Medicare Advantage |
$654.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.08
|
| Rate for Payer: Priority Health HMO/PPO |
$2,278.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,518.79
|
| Rate for Payer: Priority Health Medicare |
$440.80
|
| Rate for Payer: Priority Health Medicare |
$661.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,169.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,754.46
|
| Rate for Payer: Railroad Medicare Medicare |
$654.65
|
| Rate for Payer: Railroad Medicare Medicare |
$436.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,304.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,536.24
|
| Rate for Payer: UHC Core |
$2,186.52
|
| Rate for Payer: UHC Core |
$1,457.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$654.65
|
| Rate for Payer: UHC Exchange |
$654.65
|
| Rate for Payer: UHC Exchange |
$436.43
|
| Rate for Payer: UHC Medicare Advantage |
$654.65
|
| Rate for Payer: UHC Medicare Advantage |
$436.43
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$436.43
|
| Rate for Payer: VA VA |
$654.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,309.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,963.94
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
IP
|
$1,745.73
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,134.72 |
| Max. Negotiated Rate |
$1,571.16 |
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: Aetna Commercial |
$2,225.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,425.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,137.56
|
| Rate for Payer: BCN Commercial |
$1,349.10
|
| Rate for Payer: BCN Commercial |
$2,023.65
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$2,094.87
|
| Rate for Payer: Cofinity Commercial |
$2,251.99
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,094.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| Rate for Payer: Healthscope Commercial |
$2,356.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,309.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,963.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,483.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,225.80
|
| Rate for Payer: Nomi Health Commercial |
$1,431.50
|
| Rate for Payer: Nomi Health Commercial |
$2,147.24
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: PHP Commercial |
$2,225.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: Priority Health HMO/PPO |
$2,278.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,518.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,169.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,754.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,536.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,304.36
|
| Rate for Payer: UHC Core |
$1,457.68
|
| Rate for Payer: UHC Core |
$2,186.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,309.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,963.94
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
IP
|
$1,545.62
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,004.65 |
| Max. Negotiated Rate |
$1,391.06 |
| Rate for Payer: Aetna Commercial |
$1,313.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.69
|
| Rate for Payer: BCN Commercial |
$1,194.46
|
| Rate for Payer: Cash Price |
$1,236.50
|
| Rate for Payer: Cofinity Commercial |
$1,329.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.50
|
| Rate for Payer: Healthscope Commercial |
$1,391.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,313.78
|
| Rate for Payer: Nomi Health Commercial |
$1,267.41
|
| Rate for Payer: PHP Commercial |
$1,313.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,344.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,035.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,360.15
|
| Rate for Payer: UHC Core |
$1,290.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.21
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
OP
|
$1,545.62
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$1,391.06 |
| Rate for Payer: Aetna Commercial |
$1,313.78
|
| Rate for Payer: Aetna Medicare |
$401.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$483.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$483.01
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$386.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,270.65
|
| Rate for Payer: BCN Commercial |
$1,201.72
|
| Rate for Payer: BCN Medicare Advantage |
$386.40
|
| Rate for Payer: Cash Price |
$1,236.50
|
| Rate for Payer: Cash Price |
$1,236.50
|
| Rate for Payer: Cofinity Commercial |
$1,329.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.40
|
| Rate for Payer: Healthscope Commercial |
$1,391.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.21
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$405.73
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$444.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,313.78
|
| Rate for Payer: Nomi Health Commercial |
$1,267.41
|
| Rate for Payer: PACE Senior Care Partners |
$367.08
|
| Rate for Payer: PACE SWMI |
$386.40
|
| Rate for Payer: PHP Commercial |
$1,313.78
|
| Rate for Payer: PHP Medicare Advantage |
$386.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,344.69
|
| Rate for Payer: Priority Health Medicare |
$390.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,035.57
|
| Rate for Payer: Railroad Medicare Medicare |
$386.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,360.15
|
| Rate for Payer: UHC Core |
$1,290.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$386.40
|
| Rate for Payer: UHC Exchange |
$386.40
|
| Rate for Payer: UHC Medicare Advantage |
$386.40
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$386.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.21
|
|
|
HC CT LOWER EXTREM WO CON
|
Facility
|
IP
|
$1,349.46
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$877.15 |
| Max. Negotiated Rate |
$1,214.51 |
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,652.35
|
| Rate for Payer: BCN Commercial |
$1,042.86
|
| Rate for Payer: BCN Commercial |
$1,564.29
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$1,160.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Healthscope Commercial |
$1,214.51
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,518.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,147.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,720.56
|
| Rate for Payer: Nomi Health Commercial |
$1,106.56
|
| Rate for Payer: Nomi Health Commercial |
$1,659.84
|
| Rate for Payer: PHP Commercial |
$1,147.04
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,315.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$877.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,761.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,174.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$904.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,356.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,781.29
|
| Rate for Payer: UHC Core |
$1,126.80
|
| Rate for Payer: UHC Core |
$1,690.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.14
|
|
|
HC CT LOWER EXTREM WO CON
|
Facility
|
OP
|
$1,349.46
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$1,214.51 |
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: Aetna Medicare |
$350.86
|
| Rate for Payer: Aetna Medicare |
$526.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$421.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$632.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$421.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$632.56
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$506.05
|
| Rate for Payer: BCBS MAPPO |
$337.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.09
|
| Rate for Payer: BCN Commercial |
$1,049.21
|
| Rate for Payer: BCN Commercial |
$1,573.81
|
| Rate for Payer: BCN Medicare Advantage |
$337.37
|
| Rate for Payer: BCN Medicare Advantage |
$506.05
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,160.54
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$506.05
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Healthscope Commercial |
$1,214.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,518.14
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.23
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$581.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,147.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,720.56
|
| Rate for Payer: Nomi Health Commercial |
$1,106.56
|
| Rate for Payer: Nomi Health Commercial |
$1,659.84
|
| Rate for Payer: PACE Senior Care Partners |
$320.50
|
| Rate for Payer: PACE Senior Care Partners |
$480.75
|
| Rate for Payer: PACE SWMI |
$337.37
|
| Rate for Payer: PACE SWMI |
$506.05
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: PHP Commercial |
$1,147.04
|
| Rate for Payer: PHP Medicare Advantage |
$337.37
|
| Rate for Payer: PHP Medicare Advantage |
$506.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$877.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,315.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,761.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,174.03
|
| Rate for Payer: Priority Health Medicare |
$340.74
|
| Rate for Payer: Priority Health Medicare |
$511.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$904.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,356.21
|
| Rate for Payer: Railroad Medicare Medicare |
$506.05
|
| Rate for Payer: Railroad Medicare Medicare |
$337.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,781.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.52
|
| Rate for Payer: UHC Core |
$1,690.20
|
| Rate for Payer: UHC Core |
$1,126.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$506.05
|
| Rate for Payer: UHC Exchange |
$506.05
|
| Rate for Payer: UHC Exchange |
$337.37
|
| Rate for Payer: UHC Medicare Advantage |
$506.05
|
| Rate for Payer: UHC Medicare Advantage |
$337.37
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$337.37
|
| Rate for Payer: VA VA |
$506.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.14
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
OP
|
$1,037.49
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$933.74 |
| Rate for Payer: Aetna Commercial |
$881.87
|
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna Medicare |
$269.75
|
| Rate for Payer: Aetna Medicare |
$179.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$324.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$324.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.14
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$172.91
|
| Rate for Payer: BCBS MAPPO |
$259.37
|
| Rate for Payer: BCBS Trust/PPO |
$852.92
|
| Rate for Payer: BCBS Trust/PPO |
$568.61
|
| Rate for Payer: BCN Commercial |
$806.65
|
| Rate for Payer: BCN Commercial |
$537.77
|
| Rate for Payer: BCN Medicare Advantage |
$259.37
|
| Rate for Payer: BCN Medicare Advantage |
$172.91
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$892.24
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.91
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Healthscope Commercial |
$933.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$778.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.75
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$272.34
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.91
|
| Rate for Payer: Nomi Health Commercial |
$850.74
|
| Rate for Payer: Nomi Health Commercial |
$567.16
|
| Rate for Payer: PACE Senior Care Partners |
$246.40
|
| Rate for Payer: PACE Senior Care Partners |
$164.27
|
| Rate for Payer: PACE SWMI |
$259.37
|
| Rate for Payer: PACE SWMI |
$172.91
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: PHP Commercial |
$881.87
|
| Rate for Payer: PHP Medicare Advantage |
$259.37
|
| Rate for Payer: PHP Medicare Advantage |
$172.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.58
|
| Rate for Payer: Priority Health HMO/PPO |
$601.74
|
| Rate for Payer: Priority Health HMO/PPO |
$902.62
|
| Rate for Payer: Priority Health Medicare |
$261.97
|
| Rate for Payer: Priority Health Medicare |
$174.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$695.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.41
|
| Rate for Payer: Railroad Medicare Medicare |
$172.91
|
| Rate for Payer: Railroad Medicare Medicare |
$259.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$912.99
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: UHC Core |
$866.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.91
|
| Rate for Payer: UHC Exchange |
$172.91
|
| Rate for Payer: UHC Exchange |
$259.37
|
| Rate for Payer: UHC Medicare Advantage |
$172.91
|
| Rate for Payer: UHC Medicare Advantage |
$259.37
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$259.37
|
| Rate for Payer: VA VA |
$172.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$778.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.75
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
IP
|
$1,037.49
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$674.37 |
| Max. Negotiated Rate |
$933.74 |
| Rate for Payer: Aetna Commercial |
$881.87
|
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: BCBS Trust/PPO |
$846.90
|
| Rate for Payer: BCBS Trust/PPO |
$564.60
|
| Rate for Payer: BCN Commercial |
$801.77
|
| Rate for Payer: BCN Commercial |
$534.51
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Cofinity Commercial |
$892.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.99
|
| Rate for Payer: Healthscope Commercial |
$933.74
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$778.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.91
|
| Rate for Payer: Nomi Health Commercial |
$850.74
|
| Rate for Payer: Nomi Health Commercial |
$567.16
|
| Rate for Payer: PHP Commercial |
$881.87
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.37
|
| Rate for Payer: Priority Health HMO/PPO |
$601.74
|
| Rate for Payer: Priority Health HMO/PPO |
$902.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$695.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$912.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC Core |
$866.30
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$778.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.75
|
|
|
HC CT NECK ANGIO
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| 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 NECK ANGIO
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| 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 NEEDLE PLACE HEAD AND NECK
|
Facility
|
OP
|
$3,849.48
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$914.25 |
| Max. Negotiated Rate |
$4,491.17 |
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: Aetna Medicare |
$1,000.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,202.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,202.96
|
| Rate for Payer: BCBS Complete |
$4,491.17
|
| Rate for Payer: BCBS MAPPO |
$962.37
|
| Rate for Payer: BCBS Trust/PPO |
$3,164.66
|
| Rate for Payer: BCN Commercial |
$2,992.97
|
| Rate for Payer: BCN Medicare Advantage |
$962.37
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$962.37
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,887.11
|
| Rate for Payer: Mclaren Medicaid |
$4,277.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,010.49
|
| Rate for Payer: Meridian Medicaid |
$4,491.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,106.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: PACE Senior Care Partners |
$914.25
|
| Rate for Payer: PACE SWMI |
$962.37
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: PHP Medicare Advantage |
$962.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,277.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health HMO/PPO |
$3,349.05
|
| Rate for Payer: Priority Health Medicare |
$971.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,579.15
|
| Rate for Payer: Railroad Medicare Medicare |
$962.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,387.54
|
| Rate for Payer: UHC Core |
$3,214.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$962.37
|
| Rate for Payer: UHC Exchange |
$962.37
|
| Rate for Payer: UHC Medicare Advantage |
$962.37
|
| Rate for Payer: UHCCP Medicaid |
$4,277.02
|
| Rate for Payer: VA VA |
$962.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,887.11
|
|
|
HC CT NEEDLE PLACE HEAD AND NECK
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,502.16 |
| Max. Negotiated Rate |
$3,464.53 |
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,142.33
|
| Rate for Payer: BCN Commercial |
$2,974.88
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,887.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health HMO/PPO |
$3,349.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,579.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,387.54
|
| Rate for Payer: UHC Core |
$3,214.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,887.11
|
|
