|
HC PERQ TRANSLUM BALLOON ANGIO ARTERY/BRANCHES
|
Facility
|
IP
|
$18,900.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,154.40 |
| Max. Negotiated Rate |
$17,010.00 |
| Rate for Payer: Aetna Commercial |
$16,065.00
|
| Rate for Payer: BCBS Trust/PPO |
$15,609.51
|
| Rate for Payer: BCN Commercial |
$15,609.51
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cofinity Commercial |
$16,254.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,120.00
|
| Rate for Payer: Healthscope Commercial |
$17,010.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,175.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,065.00
|
| Rate for Payer: Nomi Health Commercial |
$15,498.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,175.00
|
| Rate for Payer: PHP Commercial |
$16,065.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16,443.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,154.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,632.00
|
| Rate for Payer: UHC Core |
$15,781.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,175.00
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
OP
|
$16,011.14
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,822.76 |
| Max. Negotiated Rate |
$14,410.03 |
| Rate for Payer: Aetna Commercial |
$13,609.47
|
| Rate for Payer: Aetna Medicare |
$4,162.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,003.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,003.48
|
| Rate for Payer: BCBS Complete |
$2,963.66
|
| Rate for Payer: BCBS MAPPO |
$4,002.78
|
| Rate for Payer: BCBS Trust/PPO |
$13,162.76
|
| Rate for Payer: BCN Commercial |
$13,162.76
|
| Rate for Payer: BCN Medicare Advantage |
$4,002.78
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cofinity Commercial |
$13,769.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,808.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,002.78
|
| Rate for Payer: Healthscope Commercial |
$14,410.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,008.35
|
| Rate for Payer: Mclaren Medicaid |
$2,822.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,202.92
|
| Rate for Payer: Meridian Medicaid |
$2,963.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,603.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,403.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,609.47
|
| Rate for Payer: Nomi Health Commercial |
$13,129.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,008.35
|
| Rate for Payer: PACE Senior Care Partners |
$3,802.65
|
| Rate for Payer: PACE SWMI |
$4,002.78
|
| Rate for Payer: PHP Commercial |
$13,609.47
|
| Rate for Payer: PHP Medicare Advantage |
$4,002.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,822.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13,929.69
|
| Rate for Payer: Priority Health Medicare |
$4,042.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,143.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4,002.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,089.80
|
| Rate for Payer: UHC Core |
$13,369.30
|
| Rate for Payer: UHC Exchange |
$4,002.78
|
| Rate for Payer: UHC Medicaid |
$2,822.76
|
| Rate for Payer: UHC Medicare Advantage |
$4,002.78
|
| Rate for Payer: UHCCP Medicaid |
$2,822.76
|
| Rate for Payer: VA VA |
$4,002.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,008.35
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
IP
|
$16,011.14
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,143.75 |
| Max. Negotiated Rate |
$14,410.03 |
| Rate for Payer: Aetna Commercial |
$13,609.47
|
| Rate for Payer: BCBS Trust/PPO |
$13,223.60
|
| Rate for Payer: BCN Commercial |
$13,223.60
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cofinity Commercial |
$13,769.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,808.91
|
| Rate for Payer: Healthscope Commercial |
$14,410.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,008.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,609.47
|
| Rate for Payer: Nomi Health Commercial |
$13,129.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,008.35
|
| Rate for Payer: PHP Commercial |
$13,609.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13,929.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,143.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,089.80
|
| Rate for Payer: UHC Core |
$13,369.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,008.35
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
IP
|
$17,328.78
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12,060.83 |
| Max. Negotiated Rate |
$15,595.90 |
| Rate for Payer: Aetna Commercial |
$14,729.46
|
| Rate for Payer: BCBS Trust/PPO |
$14,311.84
|
| Rate for Payer: BCN Commercial |
$14,311.84
|
| Rate for Payer: Cash Price |
$13,863.02
|
| Rate for Payer: Cofinity Commercial |
$14,902.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,863.02
|
| Rate for Payer: Healthscope Commercial |
$15,595.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,996.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,729.46
|
| Rate for Payer: Nomi Health Commercial |
$14,209.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,996.58
|
| Rate for Payer: PHP Commercial |
$14,729.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15,076.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,060.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,249.33
|
| Rate for Payer: UHC Core |
$14,469.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,996.58
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
OP
|
$17,328.78
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,055.06 |
| Max. Negotiated Rate |
$15,595.90 |
| Rate for Payer: Aetna Commercial |
$14,729.46
|
| Rate for Payer: Aetna Medicare |
$4,505.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,415.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,415.24
|
| Rate for Payer: BCBS Complete |
$3,207.56
|
| Rate for Payer: BCBS MAPPO |
$4,332.19
|
| Rate for Payer: BCBS Trust/PPO |
$14,245.99
|
| Rate for Payer: BCN Commercial |
$14,245.99
|
| Rate for Payer: BCN Medicare Advantage |
$4,332.19
|
| Rate for Payer: Cash Price |
$13,863.02
|
| Rate for Payer: Cofinity Commercial |
$14,902.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,863.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,332.19
|
| Rate for Payer: Healthscope Commercial |
$15,595.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,996.58
|
| Rate for Payer: Mclaren Medicaid |
$3,055.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,548.80
|
| Rate for Payer: Meridian Medicaid |
$3,207.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,982.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,765.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,729.46
|
| Rate for Payer: Nomi Health Commercial |
$14,209.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,996.58
|
| Rate for Payer: PACE Senior Care Partners |
$4,115.59
|
| Rate for Payer: PACE SWMI |
$4,332.19
|
| Rate for Payer: PHP Commercial |
$14,729.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,332.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,055.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15,076.04
|
| Rate for Payer: Priority Health Medicare |
$4,375.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,060.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4,332.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,249.33
|
| Rate for Payer: UHC Core |
$14,469.53
|
| Rate for Payer: UHC Exchange |
$4,332.19
|
| Rate for Payer: UHC Medicaid |
$3,055.06
|
| Rate for Payer: UHC Medicare Advantage |
$4,332.19
|
| Rate for Payer: UHCCP Medicaid |
$3,055.06
|
| Rate for Payer: VA VA |
$4,332.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,996.58
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
OP
|
$87.55
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Aetna Commercial |
$74.42
|
| Rate for Payer: Aetna Medicare |
$22.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.36
|
| Rate for Payer: BCBS Complete |
$16.21
|
| Rate for Payer: BCBS MAPPO |
$21.89
|
| Rate for Payer: BCBS Trust/PPO |
$71.97
|
| Rate for Payer: BCN Commercial |
$71.97
|
| Rate for Payer: BCN Medicare Advantage |
$21.89
|
| Rate for Payer: Cash Price |
$70.04
|
| Rate for Payer: Cofinity Commercial |
$75.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.89
|
| Rate for Payer: Healthscope Commercial |
$78.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.66
|
| Rate for Payer: Mclaren Medicaid |
$15.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.98
|
| Rate for Payer: Meridian Medicaid |
$16.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.42
|
| Rate for Payer: Nomi Health Commercial |
$71.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.66
|
| Rate for Payer: PACE Senior Care Partners |
$20.79
|
| Rate for Payer: PACE SWMI |
$21.89
|
| Rate for Payer: PHP Commercial |
$74.42
|
| Rate for Payer: PHP Medicare Advantage |
$21.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.17
|
| Rate for Payer: Priority Health Medicare |
$22.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.93
|
| Rate for Payer: Railroad Medicare Medicare |
$21.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.04
|
| Rate for Payer: UHC Core |
$73.10
|
| Rate for Payer: UHC Exchange |
$21.89
|
| Rate for Payer: UHC Medicaid |
$15.44
|
| Rate for Payer: UHC Medicare Advantage |
$21.89
|
| Rate for Payer: UHCCP Medicaid |
$15.44
|
| Rate for Payer: VA VA |
$21.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.66
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
IP
|
$87.55
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.93 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Aetna Commercial |
$74.42
|
| Rate for Payer: BCBS Trust/PPO |
$72.31
|
| Rate for Payer: BCN Commercial |
$72.31
|
| Rate for Payer: Cash Price |
$70.04
|
| Rate for Payer: Cofinity Commercial |
$75.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.04
|
| Rate for Payer: Healthscope Commercial |
$78.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.42
|
| Rate for Payer: Nomi Health Commercial |
$71.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.66
|
| Rate for Payer: PHP Commercial |
$74.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.04
|
| Rate for Payer: UHC Core |
$73.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.66
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
IP
|
$200.57
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$180.51 |
| Rate for Payer: Aetna Commercial |
$170.48
|
| Rate for Payer: BCBS Trust/PPO |
$165.65
|
| Rate for Payer: BCN Commercial |
$165.65
|
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Cofinity Commercial |
$172.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.46
|
| Rate for Payer: Healthscope Commercial |
$180.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.48
|
| Rate for Payer: Nomi Health Commercial |
$164.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.43
|
| Rate for Payer: PHP Commercial |
$170.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.50
|
| Rate for Payer: UHC Core |
$167.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.43
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
OP
|
$200.57
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$180.51 |
| Rate for Payer: Aetna Commercial |
$170.48
|
| Rate for Payer: Aetna Medicare |
$52.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.68
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS MAPPO |
$50.14
|
| Rate for Payer: BCBS Trust/PPO |
$164.89
|
| Rate for Payer: BCN Commercial |
$164.89
|
| Rate for Payer: BCN Medicare Advantage |
$50.14
|
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Cofinity Commercial |
$172.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.14
|
| Rate for Payer: Healthscope Commercial |
$180.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.43
|
| Rate for Payer: Mclaren Medicaid |
$35.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.65
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.48
|
| Rate for Payer: Nomi Health Commercial |
$164.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.43
|
| Rate for Payer: PACE Senior Care Partners |
$47.64
|
| Rate for Payer: PACE SWMI |
$50.14
|
| Rate for Payer: PHP Commercial |
$170.48
|
| Rate for Payer: PHP Medicare Advantage |
$50.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.50
|
| Rate for Payer: Priority Health Medicare |
$50.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.60
|
| Rate for Payer: Railroad Medicare Medicare |
$50.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.50
|
| Rate for Payer: UHC Core |
$167.48
|
| Rate for Payer: UHC Exchange |
$50.14
|
| Rate for Payer: UHC Medicaid |
$35.36
|
| Rate for Payer: UHC Medicare Advantage |
$50.14
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
| Rate for Payer: VA VA |
$50.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.43
|
|
|
HC PET AQMBF REST AND PHARM STRESS
|
Facility
|
OP
|
$5,342.76
|
|
|
Service Code
|
CPT 78434
|
| Hospital Charge Code |
40400013
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$941.93 |
| Max. Negotiated Rate |
$4,808.48 |
| Rate for Payer: Aetna Commercial |
$4,541.35
|
| Rate for Payer: Aetna Medicare |
$1,389.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,669.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,669.61
|
| Rate for Payer: BCBS Complete |
$988.94
|
| Rate for Payer: BCBS MAPPO |
$1,335.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,392.28
|
| Rate for Payer: BCN Commercial |
$4,392.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,335.69
|
| Rate for Payer: Cash Price |
$4,274.21
|
| Rate for Payer: Cofinity Commercial |
$4,594.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,274.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,335.69
|
| Rate for Payer: Healthscope Commercial |
$4,808.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,007.07
|
| Rate for Payer: Mclaren Medicaid |
$941.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,402.47
|
| Rate for Payer: Meridian Medicaid |
$988.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,536.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,469.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,541.35
|
| Rate for Payer: Nomi Health Commercial |
$4,381.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,007.07
|
| Rate for Payer: PACE Senior Care Partners |
$1,268.91
|
| Rate for Payer: PACE SWMI |
$1,335.69
|
| Rate for Payer: PHP Commercial |
$4,541.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,335.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$941.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,648.20
|
| Rate for Payer: Priority Health Medicare |
$1,349.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,718.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,335.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,701.63
|
| Rate for Payer: UHC Core |
$4,461.20
|
| Rate for Payer: UHC Exchange |
$1,335.69
|
| Rate for Payer: UHC Medicaid |
$941.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,335.69
|
| Rate for Payer: UHCCP Medicaid |
$941.93
|
| Rate for Payer: VA VA |
$1,335.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,007.07
|
|
|
HC PET AQMBF REST AND PHARM STRESS
|
Facility
|
IP
|
$5,342.76
|
|
|
Service Code
|
CPT 78434
|
| Hospital Charge Code |
40400013
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,718.56 |
| Max. Negotiated Rate |
$4,808.48 |
| Rate for Payer: Aetna Commercial |
$4,541.35
|
| Rate for Payer: BCBS Trust/PPO |
$4,412.59
|
| Rate for Payer: BCN Commercial |
$4,412.59
|
| Rate for Payer: Cash Price |
$4,274.21
|
| Rate for Payer: Cofinity Commercial |
$4,594.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,274.21
|
| Rate for Payer: Healthscope Commercial |
$4,808.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,007.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,541.35
|
| Rate for Payer: Nomi Health Commercial |
$4,381.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,007.07
|
| Rate for Payer: PHP Commercial |
$4,541.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,648.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,718.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,701.63
|
| Rate for Payer: UHC Core |
$4,461.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,007.07
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
IP
|
$5,417.04
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,770.26 |
| Max. Negotiated Rate |
$4,875.34 |
| Rate for Payer: Aetna Commercial |
$4,604.48
|
| Rate for Payer: BCBS Trust/PPO |
$4,473.93
|
| Rate for Payer: BCN Commercial |
$4,473.93
|
| Rate for Payer: Cash Price |
$4,333.63
|
| Rate for Payer: Cofinity Commercial |
$4,658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,333.63
|
| Rate for Payer: Healthscope Commercial |
$4,875.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,062.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,604.48
|
| Rate for Payer: Nomi Health Commercial |
$4,441.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,062.78
|
| Rate for Payer: PHP Commercial |
$4,604.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,712.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,770.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,767.00
|
| Rate for Payer: UHC Core |
$4,523.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,062.78
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
OP
|
$5,417.04
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$955.02 |
| Max. Negotiated Rate |
$4,875.34 |
| Rate for Payer: Aetna Commercial |
$4,604.48
|
| Rate for Payer: Aetna Medicare |
$1,408.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,692.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,692.83
|
| Rate for Payer: BCBS Complete |
$1,002.69
|
| Rate for Payer: BCBS MAPPO |
$1,354.26
|
| Rate for Payer: BCBS Trust/PPO |
$4,453.35
|
| Rate for Payer: BCN Commercial |
$4,453.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,354.26
|
| Rate for Payer: Cash Price |
$4,333.63
|
| Rate for Payer: Cofinity Commercial |
$4,658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,333.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,354.26
|
| Rate for Payer: Healthscope Commercial |
$4,875.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,062.78
|
| Rate for Payer: Mclaren Medicaid |
$955.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,421.97
|
| Rate for Payer: Meridian Medicaid |
$1,002.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,557.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,489.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,604.48
|
| Rate for Payer: Nomi Health Commercial |
$4,441.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,062.78
|
| Rate for Payer: PACE Senior Care Partners |
$1,286.55
|
| Rate for Payer: PACE SWMI |
$1,354.26
|
| Rate for Payer: PHP Commercial |
$4,604.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,354.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$955.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,712.82
|
| Rate for Payer: Priority Health Medicare |
$1,367.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,770.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,354.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,767.00
|
| Rate for Payer: UHC Core |
$4,523.23
|
| Rate for Payer: UHC Exchange |
$1,354.26
|
| Rate for Payer: UHC Medicaid |
$955.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,354.26
|
| Rate for Payer: UHCCP Medicaid |
$955.02
|
| Rate for Payer: VA VA |
$1,354.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,062.78
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
IP
|
$6,017.05
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,187.87 |
| Max. Negotiated Rate |
$5,415.35 |
| Rate for Payer: Aetna Commercial |
$5,114.49
|
| Rate for Payer: BCBS Trust/PPO |
$4,969.48
|
| Rate for Payer: BCN Commercial |
$4,969.48
|
| Rate for Payer: Cash Price |
$4,813.64
|
| Rate for Payer: Cofinity Commercial |
$5,174.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.64
|
| Rate for Payer: Healthscope Commercial |
$5,415.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,512.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.49
|
| Rate for Payer: Nomi Health Commercial |
$4,933.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,512.79
|
| Rate for Payer: PHP Commercial |
$5,114.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,234.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,187.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,295.00
|
| Rate for Payer: UHC Core |
$5,024.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,512.79
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
OP
|
$6,017.05
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,060.81 |
| Max. Negotiated Rate |
$5,415.35 |
| Rate for Payer: Aetna Commercial |
$5,114.49
|
| Rate for Payer: Aetna Medicare |
$1,564.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,880.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,880.33
|
| Rate for Payer: BCBS Complete |
$1,113.76
|
| Rate for Payer: BCBS MAPPO |
$1,504.26
|
| Rate for Payer: BCBS Trust/PPO |
$4,946.62
|
| Rate for Payer: BCN Commercial |
$4,946.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,504.26
|
| Rate for Payer: Cash Price |
$4,813.64
|
| Rate for Payer: Cofinity Commercial |
$5,174.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,504.26
|
| Rate for Payer: Healthscope Commercial |
$5,415.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,512.79
|
| Rate for Payer: Mclaren Medicaid |
$1,060.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,579.48
|
| Rate for Payer: Meridian Medicaid |
$1,113.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,729.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,654.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.49
|
| Rate for Payer: Nomi Health Commercial |
$4,933.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,512.79
|
| Rate for Payer: PACE Senior Care Partners |
$1,429.05
|
| Rate for Payer: PACE SWMI |
$1,504.26
|
| Rate for Payer: PHP Commercial |
$5,114.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,504.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,060.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,234.83
|
| Rate for Payer: Priority Health Medicare |
$1,519.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,187.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,504.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,295.00
|
| Rate for Payer: UHC Core |
$5,024.24
|
| Rate for Payer: UHC Exchange |
$1,504.26
|
| Rate for Payer: UHC Medicaid |
$1,060.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,504.26
|
| Rate for Payer: UHCCP Medicaid |
$1,060.81
|
| Rate for Payer: VA VA |
$1,504.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,512.79
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,973.67 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,715.31
|
| Rate for Payer: BCN Commercial |
$4,715.31
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Healthscope Commercial |
$5,138.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,281.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,681.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,281.98
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,967.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,973.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,024.18
|
| Rate for Payer: UHC Core |
$4,767.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,281.98
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,006.55 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: Aetna Medicare |
$1,484.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,784.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,784.16
|
| Rate for Payer: BCBS Complete |
$1,056.79
|
| Rate for Payer: BCBS MAPPO |
$1,427.33
|
| Rate for Payer: BCBS Trust/PPO |
$4,693.62
|
| Rate for Payer: BCN Commercial |
$4,693.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,427.33
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,427.33
|
| Rate for Payer: Healthscope Commercial |
$5,138.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,281.98
|
| Rate for Payer: Mclaren Medicaid |
$1,006.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,498.69
|
| Rate for Payer: Meridian Medicaid |
$1,056.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,641.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,570.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,681.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,281.98
|
| Rate for Payer: PACE Senior Care Partners |
$1,355.96
|
| Rate for Payer: PACE SWMI |
$1,427.33
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,427.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,006.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,967.09
|
| Rate for Payer: Priority Health Medicare |
$1,441.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,973.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,427.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,024.18
|
| Rate for Payer: UHC Core |
$4,767.27
|
| Rate for Payer: UHC Exchange |
$1,427.33
|
| Rate for Payer: UHC Medicaid |
$1,006.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,427.33
|
| Rate for Payer: UHCCP Medicaid |
$1,006.55
|
| Rate for Payer: VA VA |
$1,427.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,281.98
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$5,823.49
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,026.68 |
| Max. Negotiated Rate |
$5,241.14 |
| Rate for Payer: Aetna Commercial |
$4,949.97
|
| Rate for Payer: Aetna Medicare |
$1,514.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,819.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,819.84
|
| Rate for Payer: BCBS Complete |
$1,077.93
|
| Rate for Payer: BCBS MAPPO |
$1,455.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,787.49
|
| Rate for Payer: BCN Commercial |
$4,787.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,455.87
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Commercial |
$5,008.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,455.87
|
| Rate for Payer: Healthscope Commercial |
$5,241.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,367.62
|
| Rate for Payer: Mclaren Medicaid |
$1,026.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,528.67
|
| Rate for Payer: Meridian Medicaid |
$1,077.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,674.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,601.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,949.97
|
| Rate for Payer: Nomi Health Commercial |
$4,775.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| Rate for Payer: PACE Senior Care Partners |
$1,383.08
|
| Rate for Payer: PACE SWMI |
$1,455.87
|
| Rate for Payer: PHP Commercial |
$4,949.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,455.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,066.44
|
| Rate for Payer: Priority Health Medicare |
$1,470.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,053.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,455.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,124.67
|
| Rate for Payer: UHC Core |
$4,862.61
|
| Rate for Payer: UHC Exchange |
$1,455.87
|
| Rate for Payer: UHC Medicaid |
$1,026.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,455.87
|
| Rate for Payer: UHCCP Medicaid |
$1,026.68
|
| Rate for Payer: VA VA |
$1,455.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,367.62
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$5,823.49
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,053.15 |
| Max. Negotiated Rate |
$5,241.14 |
| Rate for Payer: Aetna Commercial |
$4,949.97
|
| Rate for Payer: BCBS Trust/PPO |
$4,809.62
|
| Rate for Payer: BCN Commercial |
$4,809.62
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Commercial |
$5,008.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Healthscope Commercial |
$5,241.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,367.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,949.97
|
| Rate for Payer: Nomi Health Commercial |
$4,775.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| Rate for Payer: PHP Commercial |
$4,949.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,066.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,053.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,124.67
|
| Rate for Payer: UHC Core |
$4,862.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,367.62
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
OP
|
$5,823.49
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,026.68 |
| Max. Negotiated Rate |
$5,241.14 |
| Rate for Payer: Aetna Commercial |
$4,949.97
|
| Rate for Payer: Aetna Medicare |
$1,514.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,819.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,819.84
|
| Rate for Payer: BCBS Complete |
$1,077.93
|
| Rate for Payer: BCBS MAPPO |
$1,455.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,787.49
|
| Rate for Payer: BCN Commercial |
$4,787.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,455.87
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Commercial |
$5,008.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,455.87
|
| Rate for Payer: Healthscope Commercial |
$5,241.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,367.62
|
| Rate for Payer: Mclaren Medicaid |
$1,026.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,528.67
|
| Rate for Payer: Meridian Medicaid |
$1,077.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,674.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,601.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,949.97
|
| Rate for Payer: Nomi Health Commercial |
$4,775.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| Rate for Payer: PACE Senior Care Partners |
$1,383.08
|
| Rate for Payer: PACE SWMI |
$1,455.87
|
| Rate for Payer: PHP Commercial |
$4,949.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,455.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,066.44
|
| Rate for Payer: Priority Health Medicare |
$1,470.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,053.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,455.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,124.67
|
| Rate for Payer: UHC Core |
$4,862.61
|
| Rate for Payer: UHC Exchange |
$1,455.87
|
| Rate for Payer: UHC Medicaid |
$1,026.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,455.87
|
| Rate for Payer: UHCCP Medicaid |
$1,026.68
|
| Rate for Payer: VA VA |
$1,455.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,367.62
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
IP
|
$5,823.49
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,053.15 |
| Max. Negotiated Rate |
$5,241.14 |
| Rate for Payer: Aetna Commercial |
$4,949.97
|
| Rate for Payer: BCBS Trust/PPO |
$4,809.62
|
| Rate for Payer: BCN Commercial |
$4,809.62
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Commercial |
$5,008.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Healthscope Commercial |
$5,241.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,367.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,949.97
|
| Rate for Payer: Nomi Health Commercial |
$4,775.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| Rate for Payer: PHP Commercial |
$4,949.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,066.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,053.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,124.67
|
| Rate for Payer: UHC Core |
$4,862.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,367.62
|
|
|
HC PET LIMITED AREA
|
Facility
|
OP
|
$2,679.83
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$472.45 |
| Max. Negotiated Rate |
$2,411.85 |
| Rate for Payer: Aetna Commercial |
$2,277.86
|
| Rate for Payer: Aetna Medicare |
$696.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$837.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$837.45
|
| Rate for Payer: BCBS Complete |
$496.04
|
| Rate for Payer: BCBS MAPPO |
$669.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,203.09
|
| Rate for Payer: BCN Commercial |
$2,203.09
|
| Rate for Payer: BCN Medicare Advantage |
$669.96
|
| Rate for Payer: Cash Price |
$2,143.86
|
| Rate for Payer: Cofinity Commercial |
$2,304.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.96
|
| Rate for Payer: Healthscope Commercial |
$2,411.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,009.87
|
| Rate for Payer: Mclaren Medicaid |
$472.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$703.46
|
| Rate for Payer: Meridian Medicaid |
$496.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$770.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$736.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.86
|
| Rate for Payer: Nomi Health Commercial |
$2,197.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.87
|
| Rate for Payer: PACE Senior Care Partners |
$636.46
|
| Rate for Payer: PACE SWMI |
$669.96
|
| Rate for Payer: PHP Commercial |
$2,277.86
|
| Rate for Payer: PHP Medicare Advantage |
$669.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,331.45
|
| Rate for Payer: Priority Health Medicare |
$676.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,865.16
|
| Rate for Payer: Railroad Medicare Medicare |
$669.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,358.25
|
| Rate for Payer: UHC Core |
$2,237.66
|
| Rate for Payer: UHC Exchange |
$669.96
|
| Rate for Payer: UHC Medicaid |
$472.45
|
| Rate for Payer: UHC Medicare Advantage |
$669.96
|
| Rate for Payer: UHCCP Medicaid |
$472.45
|
| Rate for Payer: VA VA |
$669.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,009.87
|
|
|
HC PET LIMITED AREA
|
Facility
|
IP
|
$2,679.83
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,865.16 |
| Max. Negotiated Rate |
$2,411.85 |
| Rate for Payer: Aetna Commercial |
$2,277.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,213.27
|
| Rate for Payer: BCN Commercial |
$2,213.27
|
| Rate for Payer: Cash Price |
$2,143.86
|
| Rate for Payer: Cofinity Commercial |
$2,304.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.86
|
| Rate for Payer: Healthscope Commercial |
$2,411.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,009.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.86
|
| Rate for Payer: Nomi Health Commercial |
$2,197.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.87
|
| Rate for Payer: PHP Commercial |
$2,277.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,331.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,865.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,358.25
|
| Rate for Payer: UHC Core |
$2,237.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,009.87
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
IP
|
$5,448.84
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,792.39 |
| Max. Negotiated Rate |
$4,903.96 |
| Rate for Payer: Aetna Commercial |
$4,631.51
|
| Rate for Payer: BCBS Trust/PPO |
$4,500.20
|
| Rate for Payer: BCN Commercial |
$4,500.20
|
| Rate for Payer: Cash Price |
$4,359.07
|
| Rate for Payer: Cofinity Commercial |
$4,686.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,359.07
|
| Rate for Payer: Healthscope Commercial |
$4,903.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,086.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,631.51
|
| Rate for Payer: Nomi Health Commercial |
$4,468.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,086.63
|
| Rate for Payer: PHP Commercial |
$4,631.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,740.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,792.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,794.98
|
| Rate for Payer: UHC Core |
$4,549.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,086.63
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
OP
|
$5,448.84
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$4,903.96 |
| Rate for Payer: Aetna Commercial |
$4,631.51
|
| Rate for Payer: Aetna Medicare |
$1,416.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,702.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,702.76
|
| Rate for Payer: BCBS Complete |
$1,008.58
|
| Rate for Payer: BCBS MAPPO |
$1,362.21
|
| Rate for Payer: BCBS Trust/PPO |
$4,479.49
|
| Rate for Payer: BCN Commercial |
$4,479.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,362.21
|
| Rate for Payer: Cash Price |
$4,359.07
|
| Rate for Payer: Cofinity Commercial |
$4,686.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,359.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,362.21
|
| Rate for Payer: Healthscope Commercial |
$4,903.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,086.63
|
| Rate for Payer: Mclaren Medicaid |
$960.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,430.32
|
| Rate for Payer: Meridian Medicaid |
$1,008.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,566.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,498.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,631.51
|
| Rate for Payer: Nomi Health Commercial |
$4,468.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,086.63
|
| Rate for Payer: PACE Senior Care Partners |
$1,294.10
|
| Rate for Payer: PACE SWMI |
$1,362.21
|
| Rate for Payer: PHP Commercial |
$4,631.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,362.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,740.49
|
| Rate for Payer: Priority Health Medicare |
$1,375.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,792.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,362.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,794.98
|
| Rate for Payer: UHC Core |
$4,549.78
|
| Rate for Payer: UHC Exchange |
$1,362.21
|
| Rate for Payer: UHC Medicaid |
$960.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,362.21
|
| Rate for Payer: UHCCP Medicaid |
$960.63
|
| Rate for Payer: VA VA |
$1,362.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,086.63
|
|
