|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
IP
|
$242.23
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.74 |
| Max. Negotiated Rate |
$218.01 |
| Rate for Payer: Aetna Commercial |
$205.90
|
| Rate for Payer: BCBS Trust/PPO |
$187.20
|
| Rate for Payer: BCN Commercial |
$187.20
|
| Rate for Payer: Cash Price |
$193.78
|
| Rate for Payer: Cofinity Commercial |
$208.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.78
|
| Rate for Payer: Healthscope Commercial |
$218.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.90
|
| Rate for Payer: PHP Commercial |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.16
|
| Rate for Payer: UHC Core |
$202.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.67
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
OP
|
$330.12
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$297.11 |
| Rate for Payer: Aetna Commercial |
$280.60
|
| Rate for Payer: Aetna Medicare |
$85.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.16
|
| Rate for Payer: BCBS Complete |
$132.05
|
| Rate for Payer: BCBS MAPPO |
$82.53
|
| Rate for Payer: BCBS Trust/PPO |
$256.67
|
| Rate for Payer: BCN Commercial |
$256.67
|
| Rate for Payer: BCN Medicare Advantage |
$82.53
|
| Rate for Payer: Cash Price |
$264.10
|
| Rate for Payer: Cofinity Commercial |
$283.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.53
|
| Rate for Payer: Healthscope Commercial |
$297.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.60
|
| Rate for Payer: PACE Senior Care Partners |
$78.40
|
| Rate for Payer: PACE SWMI |
$82.53
|
| Rate for Payer: PHP Commercial |
$280.60
|
| Rate for Payer: PHP Medicare Advantage |
$82.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.20
|
| Rate for Payer: Priority Health Medicare |
$82.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.34
|
| Rate for Payer: Railroad Medicare Medicare |
$82.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.51
|
| Rate for Payer: UHC Core |
$275.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.53
|
| Rate for Payer: UHC Medicare Advantage |
$85.01
|
| Rate for Payer: VA VA |
$82.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.59
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
IP
|
$330.12
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$201.34 |
| Max. Negotiated Rate |
$297.11 |
| Rate for Payer: Aetna Commercial |
$280.60
|
| Rate for Payer: BCBS Trust/PPO |
$255.12
|
| Rate for Payer: BCN Commercial |
$255.12
|
| Rate for Payer: Cash Price |
$264.10
|
| Rate for Payer: Cofinity Commercial |
$283.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.10
|
| Rate for Payer: Healthscope Commercial |
$297.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.60
|
| Rate for Payer: PHP Commercial |
$280.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.51
|
| Rate for Payer: UHC Core |
$275.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.59
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$35.47
|
| Rate for Payer: BCN Commercial |
$35.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: BCBS Complete |
$11.69
|
| Rate for Payer: BCBS MAPPO |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$35.69
|
| Rate for Payer: BCN Commercial |
$35.69
|
| Rate for Payer: BCN Medicare Advantage |
$11.48
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Mclaren Medicaid |
$11.13
|
| Rate for Payer: Meridian Medicaid |
$11.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Senior Care Partners |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.48
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.93
|
| Rate for Payer: Priority Health Medicare |
$11.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: Railroad Medicare Medicare |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.48
|
| Rate for Payer: UHC Medicare Advantage |
$11.82
|
| Rate for Payer: VA VA |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,057.57 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: Aetna Commercial |
$1,473.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,340.04
|
| Rate for Payer: BCN Commercial |
$1,340.04
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$1,491.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,387.20
|
| Rate for Payer: Healthscope Commercial |
$1,560.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,300.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,473.90
|
| Rate for Payer: PHP Commercial |
$1,473.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,213.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,508.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,057.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,525.92
|
| Rate for Payer: UHC Core |
$1,447.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,300.50
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$411.82 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: Aetna Commercial |
$1,473.90
|
| Rate for Payer: Aetna Medicare |
$450.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$541.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$541.88
|
| Rate for Payer: BCBS Complete |
$693.60
|
| Rate for Payer: BCBS MAPPO |
$433.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,348.18
|
| Rate for Payer: BCN Commercial |
$1,348.18
|
| Rate for Payer: BCN Medicare Advantage |
$433.50
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$1,491.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,387.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.50
|
| Rate for Payer: Healthscope Commercial |
$1,560.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,300.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$455.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$498.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,473.90
|
| Rate for Payer: PACE Senior Care Partners |
$411.82
|
| Rate for Payer: PACE SWMI |
$433.50
|
| Rate for Payer: PHP Commercial |
$1,473.90
|
| Rate for Payer: PHP Medicare Advantage |
$433.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,213.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,508.58
|
| Rate for Payer: Priority Health Medicare |
$433.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,057.57
|
| Rate for Payer: Railroad Medicare Medicare |
$433.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,525.92
|
| Rate for Payer: UHC Core |
$1,447.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.50
|
| Rate for Payer: UHC Medicare Advantage |
$446.50
|
| Rate for Payer: VA VA |
$433.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,300.50
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
OP
|
$434.34
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.16 |
| Max. Negotiated Rate |
$390.91 |
| Rate for Payer: Aetna Commercial |
$369.19
|
| Rate for Payer: Aetna Medicare |
$112.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.73
|
| Rate for Payer: BCBS Complete |
$170.23
|
| Rate for Payer: BCBS MAPPO |
$108.58
|
| Rate for Payer: BCBS Trust/PPO |
$337.70
|
| Rate for Payer: BCN Commercial |
$337.70
|
| Rate for Payer: BCN Medicare Advantage |
$108.58
|
| Rate for Payer: Cash Price |
$347.47
|
| Rate for Payer: Cash Price |
$347.47
|
| Rate for Payer: Cofinity Commercial |
$373.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.58
|
| Rate for Payer: Healthscope Commercial |
$390.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.76
|
| Rate for Payer: Mclaren Medicaid |
$162.12
|
| Rate for Payer: Meridian Medicaid |
$170.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$114.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$369.19
|
| Rate for Payer: PACE Senior Care Partners |
$103.16
|
| Rate for Payer: PACE SWMI |
$108.58
|
| Rate for Payer: PHP Commercial |
$369.19
|
| Rate for Payer: PHP Medicare Advantage |
$108.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.88
|
| Rate for Payer: Priority Health Medicare |
$108.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.90
|
| Rate for Payer: Railroad Medicare Medicare |
$108.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.22
|
| Rate for Payer: UHC Core |
$362.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.58
|
| Rate for Payer: UHC Medicare Advantage |
$111.84
|
| Rate for Payer: VA VA |
$108.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.76
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
IP
|
$434.34
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.90 |
| Max. Negotiated Rate |
$390.91 |
| Rate for Payer: Aetna Commercial |
$369.19
|
| Rate for Payer: BCBS Trust/PPO |
$335.66
|
| Rate for Payer: BCN Commercial |
$335.66
|
| Rate for Payer: Cash Price |
$347.47
|
| Rate for Payer: Cofinity Commercial |
$373.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.47
|
| Rate for Payer: Healthscope Commercial |
$390.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$369.19
|
| Rate for Payer: PHP Commercial |
$369.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.22
|
| Rate for Payer: UHC Core |
$362.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.76
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
OP
|
$433.65
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$102.99 |
| Max. Negotiated Rate |
$390.28 |
| Rate for Payer: Aetna Commercial |
$368.60
|
| Rate for Payer: Aetna Medicare |
$112.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.52
|
| Rate for Payer: BCBS Complete |
$173.46
|
| Rate for Payer: BCBS MAPPO |
$108.41
|
| Rate for Payer: BCBS Trust/PPO |
$337.16
|
| Rate for Payer: BCN Commercial |
$337.16
|
| Rate for Payer: BCN Medicare Advantage |
$108.41
|
| Rate for Payer: Cash Price |
$346.92
|
| Rate for Payer: Cofinity Commercial |
$372.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.41
|
| Rate for Payer: Healthscope Commercial |
$390.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$113.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$368.60
|
| Rate for Payer: PACE Senior Care Partners |
$102.99
|
| Rate for Payer: PACE SWMI |
$108.41
|
| Rate for Payer: PHP Commercial |
$368.60
|
| Rate for Payer: PHP Medicare Advantage |
$108.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.28
|
| Rate for Payer: Priority Health Medicare |
$108.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.48
|
| Rate for Payer: Railroad Medicare Medicare |
$108.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.61
|
| Rate for Payer: UHC Core |
$362.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.41
|
| Rate for Payer: UHC Medicare Advantage |
$111.66
|
| Rate for Payer: VA VA |
$108.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.24
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
IP
|
$433.65
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$390.28 |
| Rate for Payer: Aetna Commercial |
$368.60
|
| Rate for Payer: BCBS Trust/PPO |
$335.12
|
| Rate for Payer: BCN Commercial |
$335.12
|
| Rate for Payer: Cash Price |
$346.92
|
| Rate for Payer: Cofinity Commercial |
$372.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.92
|
| Rate for Payer: Healthscope Commercial |
$390.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$368.60
|
| Rate for Payer: PHP Commercial |
$368.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.61
|
| Rate for Payer: UHC Core |
$362.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.24
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
OP
|
$84.15
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$75.74 |
| Rate for Payer: Aetna Commercial |
$71.53
|
| Rate for Payer: Aetna Medicare |
$21.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.30
|
| Rate for Payer: BCBS Complete |
$33.66
|
| Rate for Payer: BCBS MAPPO |
$21.04
|
| Rate for Payer: BCBS Trust/PPO |
$65.43
|
| Rate for Payer: BCN Commercial |
$65.43
|
| Rate for Payer: BCN Medicare Advantage |
$21.04
|
| Rate for Payer: Cash Price |
$67.32
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.04
|
| Rate for Payer: Healthscope Commercial |
$75.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.53
|
| Rate for Payer: PACE Senior Care Partners |
$19.99
|
| Rate for Payer: PACE SWMI |
$21.04
|
| Rate for Payer: PHP Commercial |
$71.53
|
| Rate for Payer: PHP Medicare Advantage |
$21.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.21
|
| Rate for Payer: Priority Health Medicare |
$21.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.32
|
| Rate for Payer: Railroad Medicare Medicare |
$21.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.05
|
| Rate for Payer: UHC Core |
$70.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.04
|
| Rate for Payer: UHC Medicare Advantage |
$21.67
|
| Rate for Payer: VA VA |
$21.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.11
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
IP
|
$84.15
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.32 |
| Max. Negotiated Rate |
$75.74 |
| Rate for Payer: Aetna Commercial |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$65.03
|
| Rate for Payer: BCN Commercial |
$65.03
|
| Rate for Payer: Cash Price |
$67.32
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.32
|
| Rate for Payer: Healthscope Commercial |
$75.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.53
|
| Rate for Payer: PHP Commercial |
$71.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.05
|
| Rate for Payer: UHC Core |
$70.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.11
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
IP
|
$192.78
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.58 |
| Max. Negotiated Rate |
$173.50 |
| Rate for Payer: Aetna Commercial |
$163.86
|
| Rate for Payer: BCBS Trust/PPO |
$148.98
|
| Rate for Payer: BCN Commercial |
$148.98
|
| Rate for Payer: Cash Price |
$154.22
|
| Rate for Payer: Cofinity Commercial |
$165.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.22
|
| Rate for Payer: Healthscope Commercial |
$173.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.86
|
| Rate for Payer: PHP Commercial |
$163.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.65
|
| Rate for Payer: UHC Core |
$160.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.58
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
OP
|
$192.78
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$173.50 |
| Rate for Payer: Aetna Commercial |
$163.86
|
| Rate for Payer: Aetna Medicare |
$50.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.24
|
| Rate for Payer: BCBS Complete |
$77.11
|
| Rate for Payer: BCBS MAPPO |
$48.20
|
| Rate for Payer: BCBS Trust/PPO |
$149.89
|
| Rate for Payer: BCN Commercial |
$149.89
|
| Rate for Payer: BCN Medicare Advantage |
$48.20
|
| Rate for Payer: Cash Price |
$154.22
|
| Rate for Payer: Cofinity Commercial |
$165.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.20
|
| Rate for Payer: Healthscope Commercial |
$173.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.86
|
| Rate for Payer: PACE Senior Care Partners |
$45.79
|
| Rate for Payer: PACE SWMI |
$48.20
|
| Rate for Payer: PHP Commercial |
$163.86
|
| Rate for Payer: PHP Medicare Advantage |
$48.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.72
|
| Rate for Payer: Priority Health Medicare |
$48.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.58
|
| Rate for Payer: Railroad Medicare Medicare |
$48.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.65
|
| Rate for Payer: UHC Core |
$160.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.20
|
| Rate for Payer: UHC Medicare Advantage |
$49.64
|
| Rate for Payer: VA VA |
$48.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.58
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
IP
|
$5,206.69
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,175.56 |
| Max. Negotiated Rate |
$4,686.02 |
| Rate for Payer: Aetna Commercial |
$4,425.69
|
| Rate for Payer: Aetna Commercial |
$1,553.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,412.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,023.73
|
| Rate for Payer: BCN Commercial |
$1,412.12
|
| Rate for Payer: BCN Commercial |
$4,023.73
|
| Rate for Payer: Cash Price |
$4,165.35
|
| Rate for Payer: Cash Price |
$1,461.82
|
| Rate for Payer: Cofinity Commercial |
$1,571.46
|
| Rate for Payer: Cofinity Commercial |
$4,477.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,461.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,165.35
|
| Rate for Payer: Healthscope Commercial |
$1,644.55
|
| Rate for Payer: Healthscope Commercial |
$4,686.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,905.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,370.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,553.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,425.69
|
| Rate for Payer: PHP Commercial |
$4,425.69
|
| Rate for Payer: PHP Commercial |
$1,553.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,644.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,529.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,589.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,114.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,175.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,608.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,581.89
|
| Rate for Payer: UHC Core |
$1,525.78
|
| Rate for Payer: UHC Core |
$4,347.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,370.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,905.02
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
OP
|
$1,827.28
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$433.98 |
| Max. Negotiated Rate |
$1,644.55 |
| Rate for Payer: Aetna Commercial |
$1,553.19
|
| Rate for Payer: Aetna Commercial |
$4,425.69
|
| Rate for Payer: Aetna Medicare |
$1,353.74
|
| Rate for Payer: Aetna Medicare |
$475.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$571.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,627.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$571.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,627.09
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS MAPPO |
$1,301.67
|
| Rate for Payer: BCBS MAPPO |
$456.82
|
| Rate for Payer: BCBS Trust/PPO |
$4,048.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.71
|
| Rate for Payer: BCN Commercial |
$4,048.20
|
| Rate for Payer: BCN Commercial |
$1,420.71
|
| Rate for Payer: BCN Medicare Advantage |
$456.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,301.67
|
| Rate for Payer: Cash Price |
$4,165.35
|
| Rate for Payer: Cash Price |
$1,461.82
|
| Rate for Payer: Cash Price |
$4,165.35
|
| Rate for Payer: Cash Price |
$1,461.82
|
| Rate for Payer: Cofinity Commercial |
$1,571.46
|
| Rate for Payer: Cofinity Commercial |
$4,477.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,461.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,165.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,301.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$456.82
|
| Rate for Payer: Healthscope Commercial |
$4,686.02
|
| Rate for Payer: Healthscope Commercial |
$1,644.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,905.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,370.46
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,366.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$479.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$525.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,496.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,553.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,425.69
|
| Rate for Payer: PACE Senior Care Partners |
$433.98
|
| Rate for Payer: PACE Senior Care Partners |
$1,236.59
|
| Rate for Payer: PACE SWMI |
$456.82
|
| Rate for Payer: PACE SWMI |
$1,301.67
|
| Rate for Payer: PHP Commercial |
$4,425.69
|
| Rate for Payer: PHP Commercial |
$1,553.19
|
| Rate for Payer: PHP Medicare Advantage |
$456.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,301.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,644.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,589.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,529.82
|
| Rate for Payer: Priority Health Medicare |
$456.82
|
| Rate for Payer: Priority Health Medicare |
$1,301.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,175.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,114.46
|
| Rate for Payer: Railroad Medicare Medicare |
$456.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,301.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,608.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,581.89
|
| Rate for Payer: UHC Core |
$4,347.59
|
| Rate for Payer: UHC Core |
$1,525.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$456.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,301.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,340.72
|
| Rate for Payer: UHC Medicare Advantage |
$470.52
|
| Rate for Payer: VA VA |
$456.82
|
| Rate for Payer: VA VA |
$1,301.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,370.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,905.02
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
IP
|
$7,183.28
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,381.08 |
| Max. Negotiated Rate |
$6,464.95 |
| Rate for Payer: Aetna Commercial |
$6,105.79
|
| Rate for Payer: Aetna Commercial |
$4,915.89
|
| Rate for Payer: BCBS Trust/PPO |
$4,469.41
|
| Rate for Payer: BCBS Trust/PPO |
$5,551.24
|
| Rate for Payer: BCN Commercial |
$4,469.41
|
| Rate for Payer: BCN Commercial |
$5,551.24
|
| Rate for Payer: Cash Price |
$5,746.62
|
| Rate for Payer: Cash Price |
$4,626.72
|
| Rate for Payer: Cofinity Commercial |
$6,177.62
|
| Rate for Payer: Cofinity Commercial |
$4,973.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,746.62
|
| Rate for Payer: Healthscope Commercial |
$5,205.06
|
| Rate for Payer: Healthscope Commercial |
$6,464.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,387.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,337.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,915.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,105.79
|
| Rate for Payer: PHP Commercial |
$4,915.89
|
| Rate for Payer: PHP Commercial |
$6,105.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,048.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,028.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,031.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,249.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,527.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,381.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,089.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,321.29
|
| Rate for Payer: UHC Core |
$5,998.04
|
| Rate for Payer: UHC Core |
$4,829.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,387.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,337.55
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
OP
|
$7,183.28
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,026.27 |
| Max. Negotiated Rate |
$6,464.95 |
| Rate for Payer: Aetna Commercial |
$6,105.79
|
| Rate for Payer: Aetna Commercial |
$4,915.89
|
| Rate for Payer: Aetna Medicare |
$1,503.68
|
| Rate for Payer: Aetna Medicare |
$1,867.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,244.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,807.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,807.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,244.78
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS MAPPO |
$1,445.85
|
| Rate for Payer: BCBS MAPPO |
$1,795.82
|
| Rate for Payer: BCBS Trust/PPO |
$4,496.59
|
| Rate for Payer: BCBS Trust/PPO |
$5,585.00
|
| Rate for Payer: BCN Commercial |
$4,496.59
|
| Rate for Payer: BCN Commercial |
$5,585.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,445.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,795.82
|
| Rate for Payer: Cash Price |
$5,746.62
|
| Rate for Payer: Cash Price |
$4,626.72
|
| Rate for Payer: Cash Price |
$4,626.72
|
| Rate for Payer: Cash Price |
$5,746.62
|
| Rate for Payer: Cofinity Commercial |
$4,973.72
|
| Rate for Payer: Cofinity Commercial |
$6,177.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,746.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,795.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,445.85
|
| Rate for Payer: Healthscope Commercial |
$6,464.95
|
| Rate for Payer: Healthscope Commercial |
$5,205.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,337.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,387.46
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,885.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,518.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,662.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,065.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,105.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,915.89
|
| Rate for Payer: PACE Senior Care Partners |
$1,706.03
|
| Rate for Payer: PACE Senior Care Partners |
$1,373.56
|
| Rate for Payer: PACE SWMI |
$1,445.85
|
| Rate for Payer: PACE SWMI |
$1,795.82
|
| Rate for Payer: PHP Commercial |
$4,915.89
|
| Rate for Payer: PHP Commercial |
$6,105.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,445.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,795.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,048.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,028.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,249.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,031.56
|
| Rate for Payer: Priority Health Medicare |
$1,795.82
|
| Rate for Payer: Priority Health Medicare |
$1,445.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,527.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,381.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,795.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,445.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,321.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,089.39
|
| Rate for Payer: UHC Core |
$4,829.14
|
| Rate for Payer: UHC Core |
$5,998.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,445.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,795.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,849.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,489.23
|
| Rate for Payer: VA VA |
$1,445.85
|
| Rate for Payer: VA VA |
$1,795.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,337.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,387.46
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
OP
|
$5,487.60
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,026.27 |
| Max. Negotiated Rate |
$4,938.84 |
| Rate for Payer: Aetna Commercial |
$4,664.46
|
| Rate for Payer: Aetna Medicare |
$1,426.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,714.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,714.88
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS MAPPO |
$1,371.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,266.61
|
| Rate for Payer: BCN Commercial |
$4,266.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,371.90
|
| Rate for Payer: Cash Price |
$4,390.08
|
| Rate for Payer: Cash Price |
$4,390.08
|
| Rate for Payer: Cofinity Commercial |
$4,719.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,390.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,371.90
|
| Rate for Payer: Healthscope Commercial |
$4,938.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,115.70
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,440.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,577.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,664.46
|
| Rate for Payer: PACE Senior Care Partners |
$1,303.30
|
| Rate for Payer: PACE SWMI |
$1,371.90
|
| Rate for Payer: PHP Commercial |
$4,664.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,371.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,841.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,774.21
|
| Rate for Payer: Priority Health Medicare |
$1,371.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,346.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,371.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,829.09
|
| Rate for Payer: UHC Core |
$4,582.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,371.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,413.06
|
| Rate for Payer: VA VA |
$1,371.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,115.70
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
IP
|
$5,487.60
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,346.89 |
| Max. Negotiated Rate |
$4,938.84 |
| Rate for Payer: Aetna Commercial |
$4,664.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,240.82
|
| Rate for Payer: BCN Commercial |
$4,240.82
|
| Rate for Payer: Cash Price |
$4,390.08
|
| Rate for Payer: Cofinity Commercial |
$4,719.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,390.08
|
| Rate for Payer: Healthscope Commercial |
$4,938.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,115.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,664.46
|
| Rate for Payer: PHP Commercial |
$4,664.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,841.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,774.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,346.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,829.09
|
| Rate for Payer: UHC Core |
$4,582.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,115.70
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$5,597.35
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,026.27 |
| Max. Negotiated Rate |
$5,037.62 |
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: Aetna Commercial |
$6,924.10
|
| Rate for Payer: Aetna Medicare |
$1,455.31
|
| Rate for Payer: Aetna Medicare |
$2,117.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,749.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,545.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,545.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,749.17
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS MAPPO |
$1,399.34
|
| Rate for Payer: BCBS MAPPO |
$2,036.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,351.94
|
| Rate for Payer: BCBS Trust/PPO |
$6,333.52
|
| Rate for Payer: BCN Commercial |
$4,351.94
|
| Rate for Payer: BCN Commercial |
$6,333.52
|
| Rate for Payer: BCN Medicare Advantage |
$2,036.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,399.34
|
| Rate for Payer: Cash Price |
$6,516.80
|
| Rate for Payer: Cash Price |
$6,516.80
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cofinity Commercial |
$7,005.56
|
| Rate for Payer: Cofinity Commercial |
$4,813.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,477.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,516.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,036.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,399.34
|
| Rate for Payer: Healthscope Commercial |
$5,037.62
|
| Rate for Payer: Healthscope Commercial |
$7,331.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,109.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,198.01
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,138.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,469.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,341.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,609.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,924.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,757.75
|
| Rate for Payer: PACE Senior Care Partners |
$1,934.68
|
| Rate for Payer: PACE Senior Care Partners |
$1,329.37
|
| Rate for Payer: PACE SWMI |
$1,399.34
|
| Rate for Payer: PACE SWMI |
$2,036.50
|
| Rate for Payer: PHP Commercial |
$6,924.10
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,399.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,036.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,702.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,087.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,869.69
|
| Rate for Payer: Priority Health Medicare |
$2,036.50
|
| Rate for Payer: Priority Health Medicare |
$1,399.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,968.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,413.82
|
| Rate for Payer: Railroad Medicare Medicare |
$2,036.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,399.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,925.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,168.48
|
| Rate for Payer: UHC Core |
$4,673.79
|
| Rate for Payer: UHC Core |
$6,801.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,399.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,036.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,097.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,441.32
|
| Rate for Payer: VA VA |
$1,399.34
|
| Rate for Payer: VA VA |
$2,036.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,198.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,109.50
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$5,597.35
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,413.82 |
| Max. Negotiated Rate |
$5,037.62 |
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: Aetna Commercial |
$6,924.10
|
| Rate for Payer: BCBS Trust/PPO |
$6,295.23
|
| Rate for Payer: BCBS Trust/PPO |
$4,325.63
|
| Rate for Payer: BCN Commercial |
$4,325.63
|
| Rate for Payer: BCN Commercial |
$6,295.23
|
| Rate for Payer: Cash Price |
$6,516.80
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cofinity Commercial |
$4,813.72
|
| Rate for Payer: Cofinity Commercial |
$7,005.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,516.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,477.88
|
| Rate for Payer: Healthscope Commercial |
$5,037.62
|
| Rate for Payer: Healthscope Commercial |
$7,331.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,198.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,109.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,757.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,924.10
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: PHP Commercial |
$6,924.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,702.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,087.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,869.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,413.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,968.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,168.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,925.67
|
| Rate for Payer: UHC Core |
$4,673.79
|
| Rate for Payer: UHC Core |
$6,801.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,109.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,198.01
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
OP
|
$5,597.35
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,026.27 |
| Max. Negotiated Rate |
$5,037.62 |
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: Aetna Medicare |
$1,455.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,749.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,749.17
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS MAPPO |
$1,399.34
|
| Rate for Payer: BCBS Trust/PPO |
$4,351.94
|
| Rate for Payer: BCN Commercial |
$4,351.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,399.34
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cofinity Commercial |
$4,813.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,477.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,399.34
|
| Rate for Payer: Healthscope Commercial |
$5,037.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,198.01
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,469.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,609.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,757.75
|
| Rate for Payer: PACE Senior Care Partners |
$1,329.37
|
| Rate for Payer: PACE SWMI |
$1,399.34
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,399.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,869.69
|
| Rate for Payer: Priority Health Medicare |
$1,399.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,413.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,399.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,925.67
|
| Rate for Payer: UHC Core |
$4,673.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,399.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,441.32
|
| Rate for Payer: VA VA |
$1,399.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,198.01
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
IP
|
$5,597.35
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,413.82 |
| Max. Negotiated Rate |
$5,037.62 |
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,325.63
|
| Rate for Payer: BCN Commercial |
$4,325.63
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cofinity Commercial |
$4,813.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,477.88
|
| Rate for Payer: Healthscope Commercial |
$5,037.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,198.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,757.75
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,869.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,413.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,925.67
|
| Rate for Payer: UHC Core |
$4,673.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,198.01
|
|
