|
HC PERITONEOGRAM
|
Facility
|
OP
|
$568.67
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.06 |
| Max. Negotiated Rate |
$511.80 |
| Rate for Payer: Aetna Commercial |
$483.37
|
| Rate for Payer: Aetna Medicare |
$147.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.71
|
| Rate for Payer: BCBS Complete |
$416.27
|
| Rate for Payer: BCBS MAPPO |
$142.17
|
| Rate for Payer: BCBS Trust/PPO |
$467.50
|
| Rate for Payer: BCN Commercial |
$442.14
|
| Rate for Payer: BCN Medicare Advantage |
$142.17
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cofinity Commercial |
$489.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.17
|
| Rate for Payer: Healthscope Commercial |
$511.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.50
|
| Rate for Payer: Mclaren Medicaid |
$396.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.28
|
| Rate for Payer: Meridian Medicaid |
$416.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.37
|
| Rate for Payer: Nomi Health Commercial |
$466.31
|
| Rate for Payer: PACE Senior Care Partners |
$135.06
|
| Rate for Payer: PACE SWMI |
$142.17
|
| Rate for Payer: PHP Commercial |
$483.37
|
| Rate for Payer: PHP Medicare Advantage |
$142.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.64
|
| Rate for Payer: Priority Health HMO/PPO |
$494.74
|
| Rate for Payer: Priority Health Medicare |
$143.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$381.01
|
| Rate for Payer: Railroad Medicare Medicare |
$142.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.43
|
| Rate for Payer: UHC Core |
$474.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.17
|
| Rate for Payer: UHC Exchange |
$142.17
|
| Rate for Payer: UHC Medicare Advantage |
$142.17
|
| Rate for Payer: UHCCP Medicaid |
$396.42
|
| Rate for Payer: VA VA |
$142.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.50
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$568.67
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$369.64 |
| Max. Negotiated Rate |
$511.80 |
| Rate for Payer: Aetna Commercial |
$483.37
|
| Rate for Payer: BCBS Trust/PPO |
$464.21
|
| Rate for Payer: BCN Commercial |
$439.47
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cofinity Commercial |
$489.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.94
|
| Rate for Payer: Healthscope Commercial |
$511.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.37
|
| Rate for Payer: Nomi Health Commercial |
$466.31
|
| Rate for Payer: PHP Commercial |
$483.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.64
|
| Rate for Payer: Priority Health HMO/PPO |
$494.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$381.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.43
|
| Rate for Payer: UHC Core |
$474.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.50
|
|
|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
OP
|
$247.07
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.68 |
| Max. Negotiated Rate |
$222.36 |
| Rate for Payer: Aetna Commercial |
$210.01
|
| Rate for Payer: Aetna Medicare |
$64.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.21
|
| Rate for Payer: BCBS Complete |
$98.83
|
| Rate for Payer: BCBS MAPPO |
$61.77
|
| Rate for Payer: BCBS Trust/PPO |
$203.12
|
| Rate for Payer: BCN Commercial |
$192.10
|
| Rate for Payer: BCN Medicare Advantage |
$61.77
|
| Rate for Payer: Cash Price |
$197.66
|
| Rate for Payer: Cofinity Commercial |
$212.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.77
|
| Rate for Payer: Healthscope Commercial |
$222.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.01
|
| Rate for Payer: Nomi Health Commercial |
$202.60
|
| Rate for Payer: PACE Senior Care Partners |
$58.68
|
| Rate for Payer: PACE SWMI |
$61.77
|
| Rate for Payer: PHP Commercial |
$210.01
|
| Rate for Payer: PHP Medicare Advantage |
$61.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.60
|
| Rate for Payer: Priority Health HMO/PPO |
$214.95
|
| Rate for Payer: Priority Health Medicare |
$62.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.54
|
| Rate for Payer: Railroad Medicare Medicare |
$61.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.42
|
| Rate for Payer: UHC Core |
$206.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.77
|
| Rate for Payer: UHC Exchange |
$61.77
|
| Rate for Payer: UHC Medicare Advantage |
$61.77
|
| Rate for Payer: VA VA |
$61.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.30
|
|
|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
IP
|
$247.07
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$222.36 |
| Rate for Payer: Aetna Commercial |
$210.01
|
| Rate for Payer: BCBS Trust/PPO |
$201.68
|
| Rate for Payer: BCN Commercial |
$190.94
|
| Rate for Payer: Cash Price |
$197.66
|
| Rate for Payer: Cofinity Commercial |
$212.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.66
|
| Rate for Payer: Healthscope Commercial |
$222.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.01
|
| Rate for Payer: Nomi Health Commercial |
$202.60
|
| Rate for Payer: PHP Commercial |
$210.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.60
|
| Rate for Payer: Priority Health HMO/PPO |
$214.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.42
|
| Rate for Payer: UHC Core |
$206.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.30
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
OP
|
$336.72
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$79.97 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Aetna Commercial |
$286.21
|
| Rate for Payer: Aetna Medicare |
$87.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.22
|
| Rate for Payer: BCBS Complete |
$134.69
|
| Rate for Payer: BCBS MAPPO |
$84.18
|
| Rate for Payer: BCBS Trust/PPO |
$276.82
|
| Rate for Payer: BCN Commercial |
$261.80
|
| Rate for Payer: BCN Medicare Advantage |
$84.18
|
| Rate for Payer: Cash Price |
$269.38
|
| Rate for Payer: Cofinity Commercial |
$289.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.18
|
| Rate for Payer: Healthscope Commercial |
$303.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.21
|
| Rate for Payer: Nomi Health Commercial |
$276.11
|
| Rate for Payer: PACE Senior Care Partners |
$79.97
|
| Rate for Payer: PACE SWMI |
$84.18
|
| Rate for Payer: PHP Commercial |
$286.21
|
| Rate for Payer: PHP Medicare Advantage |
$84.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.87
|
| Rate for Payer: Priority Health HMO/PPO |
$292.95
|
| Rate for Payer: Priority Health Medicare |
$85.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.60
|
| Rate for Payer: Railroad Medicare Medicare |
$84.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.31
|
| Rate for Payer: UHC Core |
$281.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.18
|
| Rate for Payer: UHC Exchange |
$84.18
|
| Rate for Payer: UHC Medicare Advantage |
$84.18
|
| Rate for Payer: VA VA |
$84.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.54
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
IP
|
$336.72
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$218.87 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Aetna Commercial |
$286.21
|
| Rate for Payer: BCBS Trust/PPO |
$274.86
|
| Rate for Payer: BCN Commercial |
$260.22
|
| Rate for Payer: Cash Price |
$269.38
|
| Rate for Payer: Cofinity Commercial |
$289.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.38
|
| Rate for Payer: Healthscope Commercial |
$303.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.21
|
| Rate for Payer: Nomi Health Commercial |
$276.11
|
| Rate for Payer: PHP Commercial |
$286.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.87
|
| Rate for Payer: Priority Health HMO/PPO |
$292.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.31
|
| Rate for Payer: UHC Core |
$281.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.54
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: BCBS Trust/PPO |
$38.22
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$12.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.63
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS MAPPO |
$11.71
|
| Rate for Payer: BCBS Trust/PPO |
$38.49
|
| Rate for Payer: BCN Commercial |
$36.40
|
| Rate for Payer: BCN Medicare Advantage |
$11.71
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.71
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$10.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.29
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PACE Senior Care Partners |
$11.12
|
| Rate for Payer: PACE SWMI |
$11.71
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.71
|
| Rate for Payer: UHC Exchange |
$11.71
|
| Rate for Payer: UHC Medicare Advantage |
$11.71
|
| Rate for Payer: UHCCP Medicaid |
$10.90
|
| Rate for Payer: VA VA |
$11.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
OP
|
$1,768.68
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$420.06 |
| Max. Negotiated Rate |
$1,591.81 |
| Rate for Payer: Aetna Commercial |
$1,503.38
|
| Rate for Payer: Aetna Medicare |
$459.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$552.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$552.71
|
| Rate for Payer: BCBS Complete |
$707.47
|
| Rate for Payer: BCBS MAPPO |
$442.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,454.03
|
| Rate for Payer: BCN Commercial |
$1,375.15
|
| Rate for Payer: BCN Medicare Advantage |
$442.17
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cofinity Commercial |
$1,521.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,414.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.17
|
| Rate for Payer: Healthscope Commercial |
$1,591.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,326.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$464.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$508.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.38
|
| Rate for Payer: Nomi Health Commercial |
$1,450.32
|
| Rate for Payer: PACE Senior Care Partners |
$420.06
|
| Rate for Payer: PACE SWMI |
$442.17
|
| Rate for Payer: PHP Commercial |
$1,503.38
|
| Rate for Payer: PHP Medicare Advantage |
$442.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.64
|
| Rate for Payer: Priority Health HMO/PPO |
$1,538.75
|
| Rate for Payer: Priority Health Medicare |
$446.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,185.02
|
| Rate for Payer: Railroad Medicare Medicare |
$442.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,556.44
|
| Rate for Payer: UHC Core |
$1,476.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$442.17
|
| Rate for Payer: UHC Exchange |
$442.17
|
| Rate for Payer: UHC Medicare Advantage |
$442.17
|
| Rate for Payer: VA VA |
$442.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,326.51
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
IP
|
$1,768.68
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,149.64 |
| Max. Negotiated Rate |
$1,591.81 |
| Rate for Payer: Aetna Commercial |
$1,503.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.77
|
| Rate for Payer: BCN Commercial |
$1,366.84
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cofinity Commercial |
$1,521.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,414.94
|
| Rate for Payer: Healthscope Commercial |
$1,591.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,326.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.38
|
| Rate for Payer: Nomi Health Commercial |
$1,450.32
|
| Rate for Payer: PHP Commercial |
$1,503.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.64
|
| Rate for Payer: Priority Health HMO/PPO |
$1,538.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,185.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,556.44
|
| Rate for Payer: UHC Core |
$1,476.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,326.51
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
OP
|
$443.03
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$398.73 |
| Rate for Payer: Aetna Commercial |
$376.58
|
| Rate for Payer: Aetna Medicare |
$115.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.45
|
| Rate for Payer: BCBS Complete |
$184.65
|
| Rate for Payer: BCBS MAPPO |
$110.76
|
| Rate for Payer: BCBS Trust/PPO |
$364.21
|
| Rate for Payer: BCN Commercial |
$344.46
|
| Rate for Payer: BCN Medicare Advantage |
$110.76
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cofinity Commercial |
$381.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.76
|
| Rate for Payer: Healthscope Commercial |
$398.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.27
|
| Rate for Payer: Mclaren Medicaid |
$175.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.30
|
| Rate for Payer: Meridian Medicaid |
$184.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.58
|
| Rate for Payer: Nomi Health Commercial |
$363.28
|
| Rate for Payer: PACE Senior Care Partners |
$105.22
|
| Rate for Payer: PACE SWMI |
$110.76
|
| Rate for Payer: PHP Commercial |
$376.58
|
| Rate for Payer: PHP Medicare Advantage |
$110.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health HMO/PPO |
$385.44
|
| Rate for Payer: Priority Health Medicare |
$111.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.83
|
| Rate for Payer: Railroad Medicare Medicare |
$110.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.87
|
| Rate for Payer: UHC Core |
$369.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.76
|
| Rate for Payer: UHC Exchange |
$110.76
|
| Rate for Payer: UHC Medicare Advantage |
$110.76
|
| Rate for Payer: UHCCP Medicaid |
$175.84
|
| Rate for Payer: VA VA |
$110.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.27
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
IP
|
$443.03
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.97 |
| Max. Negotiated Rate |
$398.73 |
| Rate for Payer: Aetna Commercial |
$376.58
|
| Rate for Payer: BCBS Trust/PPO |
$361.65
|
| Rate for Payer: BCN Commercial |
$342.37
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cofinity Commercial |
$381.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.42
|
| Rate for Payer: Healthscope Commercial |
$398.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.58
|
| Rate for Payer: Nomi Health Commercial |
$363.28
|
| Rate for Payer: PHP Commercial |
$376.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health HMO/PPO |
$385.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.87
|
| Rate for Payer: UHC Core |
$369.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.27
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
OP
|
$15,697.20
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,728.09 |
| Max. Negotiated Rate |
$14,127.48 |
| Rate for Payer: Aetna Commercial |
$13,342.62
|
| Rate for Payer: Aetna Medicare |
$4,081.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,905.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,905.38
|
| Rate for Payer: BCBS Complete |
$8,609.76
|
| Rate for Payer: BCBS MAPPO |
$3,924.30
|
| Rate for Payer: BCBS Trust/PPO |
$12,904.67
|
| Rate for Payer: BCN Commercial |
$12,204.57
|
| Rate for Payer: BCN Medicare Advantage |
$3,924.30
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cofinity Commercial |
$13,499.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,557.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,924.30
|
| Rate for Payer: Healthscope Commercial |
$14,127.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,772.90
|
| Rate for Payer: Mclaren Medicaid |
$8,199.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,120.52
|
| Rate for Payer: Meridian Medicaid |
$8,609.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,512.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,342.62
|
| Rate for Payer: Nomi Health Commercial |
$12,871.70
|
| Rate for Payer: PACE Senior Care Partners |
$3,728.09
|
| Rate for Payer: PACE SWMI |
$3,924.30
|
| Rate for Payer: PHP Commercial |
$13,342.62
|
| Rate for Payer: PHP Medicare Advantage |
$3,924.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,199.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,203.18
|
| Rate for Payer: Priority Health HMO/PPO |
$13,656.56
|
| Rate for Payer: Priority Health Medicare |
$3,963.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,517.12
|
| Rate for Payer: Railroad Medicare Medicare |
$3,924.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,813.54
|
| Rate for Payer: UHC Core |
$13,107.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,924.30
|
| Rate for Payer: UHC Exchange |
$3,924.30
|
| Rate for Payer: UHC Medicare Advantage |
$3,924.30
|
| Rate for Payer: UHCCP Medicaid |
$8,199.23
|
| Rate for Payer: VA VA |
$3,924.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,772.90
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
IP
|
$15,697.20
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,203.18 |
| Max. Negotiated Rate |
$14,127.48 |
| Rate for Payer: Aetna Commercial |
$13,342.62
|
| Rate for Payer: BCBS Trust/PPO |
$12,813.62
|
| Rate for Payer: BCN Commercial |
$12,130.80
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cofinity Commercial |
$13,499.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,557.76
|
| Rate for Payer: Healthscope Commercial |
$14,127.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,772.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,342.62
|
| Rate for Payer: Nomi Health Commercial |
$12,871.70
|
| Rate for Payer: PHP Commercial |
$13,342.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,203.18
|
| Rate for Payer: Priority Health HMO/PPO |
$13,656.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,517.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,813.54
|
| Rate for Payer: UHC Core |
$13,107.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,772.90
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
IP
|
$16,989.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$11,042.85 |
| Max. Negotiated Rate |
$15,290.10 |
| Rate for Payer: Aetna Commercial |
$14,440.65
|
| Rate for Payer: BCBS Trust/PPO |
$13,868.12
|
| Rate for Payer: BCN Commercial |
$13,129.10
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cofinity Commercial |
$14,610.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,591.20
|
| Rate for Payer: Healthscope Commercial |
$15,290.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,741.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,440.65
|
| Rate for Payer: Nomi Health Commercial |
$13,930.98
|
| Rate for Payer: PHP Commercial |
$14,440.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,042.85
|
| Rate for Payer: Priority Health HMO/PPO |
$14,780.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,382.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,950.32
|
| Rate for Payer: UHC Core |
$14,185.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,741.75
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
OP
|
$16,989.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,034.89 |
| Max. Negotiated Rate |
$15,290.10 |
| Rate for Payer: Aetna Commercial |
$14,440.65
|
| Rate for Payer: Aetna Medicare |
$4,417.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,309.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,309.06
|
| Rate for Payer: BCBS Complete |
$6,795.60
|
| Rate for Payer: BCBS MAPPO |
$4,247.25
|
| Rate for Payer: BCBS Trust/PPO |
$13,966.66
|
| Rate for Payer: BCN Commercial |
$13,208.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,247.25
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cofinity Commercial |
$14,610.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,591.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,247.25
|
| Rate for Payer: Healthscope Commercial |
$15,290.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,741.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,459.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,884.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,440.65
|
| Rate for Payer: Nomi Health Commercial |
$13,930.98
|
| Rate for Payer: PACE Senior Care Partners |
$4,034.89
|
| Rate for Payer: PACE SWMI |
$4,247.25
|
| Rate for Payer: PHP Commercial |
$14,440.65
|
| Rate for Payer: PHP Medicare Advantage |
$4,247.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,042.85
|
| Rate for Payer: Priority Health HMO/PPO |
$14,780.43
|
| Rate for Payer: Priority Health Medicare |
$4,289.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,382.63
|
| Rate for Payer: Railroad Medicare Medicare |
$4,247.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,950.32
|
| Rate for Payer: UHC Core |
$14,185.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,247.25
|
| Rate for Payer: UHC Exchange |
$4,247.25
|
| Rate for Payer: UHC Medicare Advantage |
$4,247.25
|
| Rate for Payer: VA VA |
$4,247.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,741.75
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
OP
|
$85.83
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: Aetna Medicare |
$22.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.82
|
| Rate for Payer: BCBS Complete |
$34.33
|
| Rate for Payer: BCBS MAPPO |
$21.46
|
| Rate for Payer: BCBS Trust/PPO |
$70.56
|
| Rate for Payer: BCN Commercial |
$66.73
|
| Rate for Payer: BCN Medicare Advantage |
$21.46
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Commercial |
$73.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$77.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Nomi Health Commercial |
$70.38
|
| Rate for Payer: PACE Senior Care Partners |
$20.38
|
| Rate for Payer: PACE SWMI |
$21.46
|
| Rate for Payer: PHP Commercial |
$72.96
|
| Rate for Payer: PHP Medicare Advantage |
$21.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.79
|
| Rate for Payer: Priority Health HMO/PPO |
$74.67
|
| Rate for Payer: Priority Health Medicare |
$21.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.51
|
| Rate for Payer: Railroad Medicare Medicare |
$21.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.53
|
| Rate for Payer: UHC Core |
$71.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.46
|
| Rate for Payer: UHC Exchange |
$21.46
|
| Rate for Payer: UHC Medicare Advantage |
$21.46
|
| Rate for Payer: VA VA |
$21.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.37
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
IP
|
$85.83
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.79 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: BCBS Trust/PPO |
$70.06
|
| Rate for Payer: BCN Commercial |
$66.33
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Commercial |
$73.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$77.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Nomi Health Commercial |
$70.38
|
| Rate for Payer: PHP Commercial |
$72.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.79
|
| Rate for Payer: Priority Health HMO/PPO |
$74.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.53
|
| Rate for Payer: UHC Core |
$71.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.37
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
OP
|
$196.64
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna Commercial |
$167.14
|
| Rate for Payer: Aetna Medicare |
$51.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.45
|
| Rate for Payer: BCBS Complete |
$78.66
|
| Rate for Payer: BCBS MAPPO |
$49.16
|
| Rate for Payer: BCBS Trust/PPO |
$161.66
|
| Rate for Payer: BCN Commercial |
$152.89
|
| Rate for Payer: BCN Medicare Advantage |
$49.16
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$169.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.16
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: Nomi Health Commercial |
$161.24
|
| Rate for Payer: PACE Senior Care Partners |
$46.70
|
| Rate for Payer: PACE SWMI |
$49.16
|
| Rate for Payer: PHP Commercial |
$167.14
|
| Rate for Payer: PHP Medicare Advantage |
$49.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.82
|
| Rate for Payer: Priority Health HMO/PPO |
$171.08
|
| Rate for Payer: Priority Health Medicare |
$49.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.75
|
| Rate for Payer: Railroad Medicare Medicare |
$49.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.04
|
| Rate for Payer: UHC Core |
$164.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.16
|
| Rate for Payer: UHC Exchange |
$49.16
|
| Rate for Payer: UHC Medicare Advantage |
$49.16
|
| Rate for Payer: VA VA |
$49.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.48
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
IP
|
$196.64
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.82 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna Commercial |
$167.14
|
| Rate for Payer: BCBS Trust/PPO |
$160.52
|
| Rate for Payer: BCN Commercial |
$151.96
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$169.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: Nomi Health Commercial |
$161.24
|
| Rate for Payer: PHP Commercial |
$167.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.82
|
| Rate for Payer: Priority Health HMO/PPO |
$171.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.04
|
| Rate for Payer: UHC Core |
$164.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.48
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
IP
|
$5,310.82
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,452.03 |
| Max. Negotiated Rate |
$4,779.74 |
| Rate for Payer: Aetna Commercial |
$4,514.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,335.22
|
| Rate for Payer: BCN Commercial |
$4,104.20
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cofinity Commercial |
$4,567.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,248.66
|
| Rate for Payer: Healthscope Commercial |
$4,779.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,983.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,514.20
|
| Rate for Payer: Nomi Health Commercial |
$4,354.87
|
| Rate for Payer: PHP Commercial |
$4,514.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,452.03
|
| Rate for Payer: Priority Health HMO/PPO |
$4,620.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,558.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,673.52
|
| Rate for Payer: UHC Core |
$4,434.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,983.11
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
OP
|
$5,310.82
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,054.56 |
| Max. Negotiated Rate |
$4,779.74 |
| Rate for Payer: Aetna Commercial |
$4,514.20
|
| Rate for Payer: Aetna Medicare |
$1,380.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,659.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,659.63
|
| Rate for Payer: BCBS Complete |
$1,107.36
|
| Rate for Payer: BCBS MAPPO |
$1,327.70
|
| Rate for Payer: BCBS Trust/PPO |
$4,366.03
|
| Rate for Payer: BCN Commercial |
$4,129.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,327.70
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cofinity Commercial |
$4,567.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,248.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,327.70
|
| Rate for Payer: Healthscope Commercial |
$4,779.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,983.11
|
| Rate for Payer: Mclaren Medicaid |
$1,054.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,394.09
|
| Rate for Payer: Meridian Medicaid |
$1,107.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,526.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,514.20
|
| Rate for Payer: Nomi Health Commercial |
$4,354.87
|
| Rate for Payer: PACE Senior Care Partners |
$1,261.32
|
| Rate for Payer: PACE SWMI |
$1,327.70
|
| Rate for Payer: PHP Commercial |
$4,514.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,327.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,054.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,452.03
|
| Rate for Payer: Priority Health HMO/PPO |
$4,620.41
|
| Rate for Payer: Priority Health Medicare |
$1,340.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,558.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,327.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,673.52
|
| Rate for Payer: UHC Core |
$4,434.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,327.70
|
| Rate for Payer: UHC Exchange |
$1,327.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,327.70
|
| Rate for Payer: UHCCP Medicaid |
$1,054.56
|
| Rate for Payer: VA VA |
$1,327.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,983.11
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
IP
|
$5,899.07
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,834.40 |
| Max. Negotiated Rate |
$5,309.16 |
| Rate for Payer: Aetna Commercial |
$5,014.21
|
| Rate for Payer: BCBS Trust/PPO |
$4,815.41
|
| Rate for Payer: BCN Commercial |
$4,558.80
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cofinity Commercial |
$5,073.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,719.26
|
| Rate for Payer: Healthscope Commercial |
$5,309.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,424.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,014.21
|
| Rate for Payer: Nomi Health Commercial |
$4,837.24
|
| Rate for Payer: PHP Commercial |
$5,014.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,834.40
|
| Rate for Payer: Priority Health HMO/PPO |
$5,132.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,952.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,191.18
|
| Rate for Payer: UHC Core |
$4,925.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,424.30
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
OP
|
$5,899.07
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,054.56 |
| Max. Negotiated Rate |
$5,309.16 |
| Rate for Payer: Aetna Commercial |
$5,014.21
|
| Rate for Payer: Aetna Medicare |
$1,533.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,843.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,843.46
|
| Rate for Payer: BCBS Complete |
$1,107.36
|
| Rate for Payer: BCBS MAPPO |
$1,474.77
|
| Rate for Payer: BCBS Trust/PPO |
$4,849.63
|
| Rate for Payer: BCN Commercial |
$4,586.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,474.77
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cofinity Commercial |
$5,073.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,719.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,474.77
|
| Rate for Payer: Healthscope Commercial |
$5,309.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,424.30
|
| Rate for Payer: Mclaren Medicaid |
$1,054.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,548.51
|
| Rate for Payer: Meridian Medicaid |
$1,107.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,695.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,014.21
|
| Rate for Payer: Nomi Health Commercial |
$4,837.24
|
| Rate for Payer: PACE Senior Care Partners |
$1,401.03
|
| Rate for Payer: PACE SWMI |
$1,474.77
|
| Rate for Payer: PHP Commercial |
$5,014.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,474.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,054.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,834.40
|
| Rate for Payer: Priority Health HMO/PPO |
$5,132.19
|
| Rate for Payer: Priority Health Medicare |
$1,489.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,952.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,474.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,191.18
|
| Rate for Payer: UHC Core |
$4,925.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,474.77
|
| Rate for Payer: UHC Exchange |
$1,474.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,474.77
|
| Rate for Payer: UHCCP Medicaid |
$1,054.56
|
| Rate for Payer: VA VA |
$1,474.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,424.30
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
IP
|
$5,597.35
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,638.28 |
| Max. Negotiated Rate |
$5,037.61 |
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,569.12
|
| 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 |
$5,037.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,198.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,757.75
|
| Rate for Payer: Nomi Health Commercial |
$4,589.83
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,638.28
|
| Rate for Payer: Priority Health HMO/PPO |
$4,869.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,750.22
|
| 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
|
|
