|
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
|
OP
|
$5,310.82
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,033.24 |
| 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 |
$1,084.97
|
| 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 |
$3,983.12
|
| Rate for Payer: Mclaren Medicaid |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,394.09
|
| Rate for Payer: Meridian Medicaid |
$1,084.97
|
| 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 |
$1,033.24
|
| 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 |
$1,033.24
|
| Rate for Payer: VA VA |
$1,327.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,983.12
|
|
|
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 |
$3,983.12
|
| 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 |
$3,983.12
|
|
|
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 |
$1,033.24 |
| 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 |
$1,084.97
|
| 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 |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,548.51
|
| Rate for Payer: Meridian Medicaid |
$1,084.97
|
| 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 |
$1,033.24
|
| 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 |
$1,033.24
|
| Rate for Payer: VA VA |
$1,474.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,424.30
|
|
|
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 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 |
$5,037.62 |
| 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 |
$5,037.62
|
| 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
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
OP
|
$5,597.35
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,033.24 |
| 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 |
$1,084.97
|
| Rate for Payer: BCBS MAPPO |
$1,399.34
|
| Rate for Payer: BCBS Trust/PPO |
$4,601.58
|
| 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 |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,469.30
|
| Rate for Payer: Meridian Medicaid |
$1,084.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,609.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,757.75
|
| Rate for Payer: Nomi Health Commercial |
$4,589.83
|
| 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 |
$1,033.24
|
| 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 Medicare |
$1,413.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,750.22
|
| 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 Exchange |
$1,399.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,399.34
|
| Rate for Payer: UHCCP Medicaid |
$1,033.24
|
| Rate for Payer: VA VA |
$1,399.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,198.01
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,711.04 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,660.50
|
| Rate for Payer: BCN Commercial |
$4,412.15
|
| 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: PHP Commercial |
$4,852.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.04
|
| Rate for Payer: Priority Health HMO/PPO |
$4,967.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,825.23
|
| 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 SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,033.24 |
| 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 |
$1,084.97
|
| Rate for Payer: BCBS MAPPO |
$1,427.32
|
| Rate for Payer: BCBS Trust/PPO |
$4,693.62
|
| Rate for Payer: BCN Commercial |
$4,438.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,427.32
|
| Rate for Payer: Cash Price |
$4,567.44
|
| 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 |
$1,427.32
|
| Rate for Payer: Healthscope Commercial |
$5,138.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,281.98
|
| Rate for Payer: Mclaren Medicaid |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,498.69
|
| Rate for Payer: Meridian Medicaid |
$1,084.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,641.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,681.63
|
| Rate for Payer: PACE Senior Care Partners |
$1,355.96
|
| Rate for Payer: PACE SWMI |
$1,427.32
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,427.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,033.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.04
|
| Rate for Payer: Priority Health HMO/PPO |
$4,967.09
|
| Rate for Payer: Priority Health Medicare |
$1,441.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,825.23
|
| Rate for Payer: Railroad Medicare Medicare |
$1,427.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,024.18
|
| Rate for Payer: UHC Core |
$4,767.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,427.32
|
| Rate for Payer: UHC Exchange |
$1,427.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,427.32
|
| Rate for Payer: UHCCP Medicaid |
$1,033.24
|
| Rate for Payer: VA VA |
$1,427.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,281.98
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,033.24 |
| 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 |
$1,084.97
|
| Rate for Payer: BCBS MAPPO |
$1,427.32
|
| Rate for Payer: BCBS Trust/PPO |
$4,693.62
|
| Rate for Payer: BCN Commercial |
$4,438.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,427.32
|
| Rate for Payer: Cash Price |
$4,567.44
|
| 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 |
$1,427.32
|
| Rate for Payer: Healthscope Commercial |
$5,138.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,281.98
|
| Rate for Payer: Mclaren Medicaid |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,498.69
|
| Rate for Payer: Meridian Medicaid |
$1,084.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,641.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,681.63
|
| Rate for Payer: PACE Senior Care Partners |
$1,355.96
|
| Rate for Payer: PACE SWMI |
$1,427.32
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,427.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,033.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.04
|
| Rate for Payer: Priority Health HMO/PPO |
$4,967.09
|
| Rate for Payer: Priority Health Medicare |
$1,441.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,825.23
|
| Rate for Payer: Railroad Medicare Medicare |
$1,427.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,024.18
|
| Rate for Payer: UHC Core |
$4,767.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,427.32
|
| Rate for Payer: UHC Exchange |
$1,427.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,427.32
|
| Rate for Payer: UHCCP Medicaid |
$1,033.24
|
| Rate for Payer: VA VA |
$1,427.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,281.98
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,711.04 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,660.50
|
| Rate for Payer: BCN Commercial |
$4,412.15
|
| 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: PHP Commercial |
$4,852.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.04
|
| Rate for Payer: Priority Health HMO/PPO |
$4,967.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,825.23
|
| 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 LIMITED AREA
|
Facility
|
OP
|
$2,627.28
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$623.98 |
| Max. Negotiated Rate |
$2,364.55 |
| Rate for Payer: Aetna Commercial |
$2,233.19
|
| Rate for Payer: Aetna Medicare |
$683.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$821.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$821.02
|
| Rate for Payer: BCBS Complete |
$971.08
|
| Rate for Payer: BCBS MAPPO |
$656.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.89
|
| Rate for Payer: BCN Commercial |
$2,042.71
|
| Rate for Payer: BCN Medicare Advantage |
$656.82
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cofinity Commercial |
$2,259.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$656.82
|
| Rate for Payer: Healthscope Commercial |
$2,364.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.46
|
| Rate for Payer: Mclaren Medicaid |
$924.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$689.66
|
| Rate for Payer: Meridian Medicaid |
$971.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$755.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.19
|
| Rate for Payer: Nomi Health Commercial |
$2,154.37
|
| Rate for Payer: PACE Senior Care Partners |
$623.98
|
| Rate for Payer: PACE SWMI |
$656.82
|
| Rate for Payer: PHP Commercial |
$2,233.19
|
| Rate for Payer: PHP Medicare Advantage |
$656.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$924.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,707.73
|
| Rate for Payer: Priority Health HMO/PPO |
$2,285.73
|
| Rate for Payer: Priority Health Medicare |
$663.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,760.28
|
| Rate for Payer: Railroad Medicare Medicare |
$656.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,312.01
|
| Rate for Payer: UHC Core |
$2,193.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$656.82
|
| Rate for Payer: UHC Exchange |
$656.82
|
| Rate for Payer: UHC Medicare Advantage |
$656.82
|
| Rate for Payer: UHCCP Medicaid |
$924.77
|
| Rate for Payer: VA VA |
$656.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.46
|
|
|
HC PET LIMITED AREA
|
Facility
|
IP
|
$2,627.28
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,707.73 |
| Max. Negotiated Rate |
$2,364.55 |
| Rate for Payer: Aetna Commercial |
$2,233.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,144.65
|
| Rate for Payer: BCN Commercial |
$2,030.36
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cofinity Commercial |
$2,259.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.82
|
| Rate for Payer: Healthscope Commercial |
$2,364.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.19
|
| Rate for Payer: Nomi Health Commercial |
$2,154.37
|
| Rate for Payer: PHP Commercial |
$2,233.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,707.73
|
| Rate for Payer: Priority Health HMO/PPO |
$2,285.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,760.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,312.01
|
| Rate for Payer: UHC Core |
$2,193.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.46
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
IP
|
$5,342.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,472.30 |
| Max. Negotiated Rate |
$4,807.80 |
| Rate for Payer: Aetna Commercial |
$4,540.70
|
| Rate for Payer: BCBS Trust/PPO |
$4,360.67
|
| Rate for Payer: BCN Commercial |
$4,128.30
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cofinity Commercial |
$4,594.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,273.60
|
| Rate for Payer: Healthscope Commercial |
$4,807.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,006.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,540.70
|
| Rate for Payer: Nomi Health Commercial |
$4,380.44
|
| Rate for Payer: PHP Commercial |
$4,540.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,472.30
|
| Rate for Payer: Priority Health HMO/PPO |
$4,647.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,579.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,700.96
|
| Rate for Payer: UHC Core |
$4,460.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,006.50
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
OP
|
$5,342.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,268.72 |
| Max. Negotiated Rate |
$4,807.80 |
| Rate for Payer: Aetna Commercial |
$4,540.70
|
| Rate for Payer: Aetna Medicare |
$1,388.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,669.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,669.38
|
| Rate for Payer: BCBS Complete |
$1,674.03
|
| Rate for Payer: BCBS MAPPO |
$1,335.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,391.66
|
| Rate for Payer: BCN Commercial |
$4,153.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,335.50
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cofinity Commercial |
$4,594.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,273.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,335.50
|
| Rate for Payer: Healthscope Commercial |
$4,807.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,006.50
|
| Rate for Payer: Mclaren Medicaid |
$1,594.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,402.28
|
| Rate for Payer: Meridian Medicaid |
$1,674.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,535.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,540.70
|
| Rate for Payer: Nomi Health Commercial |
$4,380.44
|
| Rate for Payer: PACE Senior Care Partners |
$1,268.72
|
| Rate for Payer: PACE SWMI |
$1,335.50
|
| Rate for Payer: PHP Commercial |
$4,540.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,335.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,594.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,472.30
|
| Rate for Payer: Priority Health HMO/PPO |
$4,647.54
|
| Rate for Payer: Priority Health Medicare |
$1,348.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,579.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,335.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,700.96
|
| Rate for Payer: UHC Core |
$4,460.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,335.50
|
| Rate for Payer: UHC Exchange |
$1,335.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,335.50
|
| Rate for Payer: UHCCP Medicaid |
$1,594.21
|
| Rate for Payer: VA VA |
$1,335.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,006.50
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
IP
|
$4,863.36
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,161.18 |
| Max. Negotiated Rate |
$4,377.02 |
| Rate for Payer: Aetna Commercial |
$4,133.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,969.96
|
| Rate for Payer: BCN Commercial |
$3,758.40
|
| Rate for Payer: Cash Price |
$3,890.69
|
| Rate for Payer: Cofinity Commercial |
$4,182.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,890.69
|
| Rate for Payer: Healthscope Commercial |
$4,377.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,647.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,133.86
|
| Rate for Payer: Nomi Health Commercial |
$3,987.96
|
| Rate for Payer: PHP Commercial |
$4,133.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,161.18
|
| Rate for Payer: Priority Health HMO/PPO |
$4,231.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,258.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,279.76
|
| Rate for Payer: UHC Core |
$4,060.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,647.52
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
OP
|
$4,863.36
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,033.24 |
| Max. Negotiated Rate |
$4,377.02 |
| Rate for Payer: Aetna Commercial |
$4,133.86
|
| Rate for Payer: Aetna Medicare |
$1,264.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,519.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,519.80
|
| Rate for Payer: BCBS Complete |
$1,084.97
|
| Rate for Payer: BCBS MAPPO |
$1,215.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,998.17
|
| Rate for Payer: BCN Commercial |
$3,781.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,215.84
|
| Rate for Payer: Cash Price |
$3,890.69
|
| Rate for Payer: Cash Price |
$3,890.69
|
| Rate for Payer: Cofinity Commercial |
$4,182.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,890.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,215.84
|
| Rate for Payer: Healthscope Commercial |
$4,377.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,647.52
|
| Rate for Payer: Mclaren Medicaid |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,276.63
|
| Rate for Payer: Meridian Medicaid |
$1,084.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,398.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,133.86
|
| Rate for Payer: Nomi Health Commercial |
$3,987.96
|
| Rate for Payer: PACE Senior Care Partners |
$1,155.05
|
| Rate for Payer: PACE SWMI |
$1,215.84
|
| Rate for Payer: PHP Commercial |
$4,133.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,215.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,033.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,161.18
|
| Rate for Payer: Priority Health HMO/PPO |
$4,231.12
|
| Rate for Payer: Priority Health Medicare |
$1,228.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,258.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,215.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,279.76
|
| Rate for Payer: UHC Core |
$4,060.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,215.84
|
| Rate for Payer: UHC Exchange |
$1,215.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,215.84
|
| Rate for Payer: UHCCP Medicaid |
$1,033.24
|
| Rate for Payer: VA VA |
$1,215.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,647.52
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
IP
|
$4,328.06
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,813.24 |
| Max. Negotiated Rate |
$3,895.25 |
| Rate for Payer: Aetna Commercial |
$3,678.85
|
| Rate for Payer: BCBS Trust/PPO |
$3,533.00
|
| Rate for Payer: BCN Commercial |
$3,344.72
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cofinity Commercial |
$3,722.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,462.45
|
| Rate for Payer: Healthscope Commercial |
$3,895.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,246.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,678.85
|
| Rate for Payer: Nomi Health Commercial |
$3,549.01
|
| Rate for Payer: PHP Commercial |
$3,678.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,813.24
|
| Rate for Payer: Priority Health HMO/PPO |
$3,765.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,899.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,808.69
|
| Rate for Payer: UHC Core |
$3,613.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,246.04
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
OP
|
$4,328.06
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,027.91 |
| Max. Negotiated Rate |
$3,895.25 |
| Rate for Payer: Aetna Commercial |
$3,678.85
|
| Rate for Payer: Aetna Medicare |
$1,125.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,352.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,352.52
|
| Rate for Payer: BCBS Complete |
$1,084.97
|
| Rate for Payer: BCBS MAPPO |
$1,082.02
|
| Rate for Payer: BCBS Trust/PPO |
$3,558.10
|
| Rate for Payer: BCN Commercial |
$3,365.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,082.02
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cofinity Commercial |
$3,722.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,462.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,082.02
|
| Rate for Payer: Healthscope Commercial |
$3,895.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,246.04
|
| Rate for Payer: Mclaren Medicaid |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,136.12
|
| Rate for Payer: Meridian Medicaid |
$1,084.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,244.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,678.85
|
| Rate for Payer: Nomi Health Commercial |
$3,549.01
|
| Rate for Payer: PACE Senior Care Partners |
$1,027.91
|
| Rate for Payer: PACE SWMI |
$1,082.02
|
| Rate for Payer: PHP Commercial |
$3,678.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,082.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,033.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,813.24
|
| Rate for Payer: Priority Health HMO/PPO |
$3,765.41
|
| Rate for Payer: Priority Health Medicare |
$1,092.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,899.80
|
| Rate for Payer: Railroad Medicare Medicare |
$1,082.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,808.69
|
| Rate for Payer: UHC Core |
$3,613.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,082.02
|
| Rate for Payer: UHC Exchange |
$1,082.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,082.02
|
| Rate for Payer: UHCCP Medicaid |
$1,033.24
|
| Rate for Payer: VA VA |
$1,082.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,246.04
|
|
|
HC PET WHOLE BODY
|
Facility
|
OP
|
$5,702.43
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,033.24 |
| Max. Negotiated Rate |
$5,132.19 |
| Rate for Payer: Aetna Commercial |
$4,847.07
|
| Rate for Payer: Aetna Medicare |
$1,482.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,782.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,782.01
|
| Rate for Payer: BCBS Complete |
$1,084.97
|
| Rate for Payer: BCBS MAPPO |
$1,425.61
|
| Rate for Payer: BCBS Trust/PPO |
$4,687.97
|
| Rate for Payer: BCN Commercial |
$4,433.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.61
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cofinity Commercial |
$4,904.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,561.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.61
|
| Rate for Payer: Healthscope Commercial |
$5,132.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,276.82
|
| Rate for Payer: Mclaren Medicaid |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.89
|
| Rate for Payer: Meridian Medicaid |
$1,084.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,639.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,847.07
|
| Rate for Payer: Nomi Health Commercial |
$4,675.99
|
| Rate for Payer: PACE Senior Care Partners |
$1,354.33
|
| Rate for Payer: PACE SWMI |
$1,425.61
|
| Rate for Payer: PHP Commercial |
$4,847.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,033.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,706.58
|
| Rate for Payer: Priority Health HMO/PPO |
$4,961.11
|
| Rate for Payer: Priority Health Medicare |
$1,439.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,820.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1,425.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,018.14
|
| Rate for Payer: UHC Core |
$4,761.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,425.61
|
| Rate for Payer: UHC Exchange |
$1,425.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,425.61
|
| Rate for Payer: UHCCP Medicaid |
$1,033.24
|
| Rate for Payer: VA VA |
$1,425.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,276.82
|
|
|
HC PET WHOLE BODY
|
Facility
|
IP
|
$5,702.43
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,706.58 |
| Max. Negotiated Rate |
$5,132.19 |
| Rate for Payer: Aetna Commercial |
$4,847.07
|
| Rate for Payer: BCBS Trust/PPO |
$4,654.89
|
| Rate for Payer: BCN Commercial |
$4,406.84
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cofinity Commercial |
$4,904.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,561.94
|
| Rate for Payer: Healthscope Commercial |
$5,132.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,276.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,847.07
|
| Rate for Payer: Nomi Health Commercial |
$4,675.99
|
| Rate for Payer: PHP Commercial |
$4,847.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,706.58
|
| Rate for Payer: Priority Health HMO/PPO |
$4,961.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,820.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,018.14
|
| Rate for Payer: UHC Core |
$4,761.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,276.82
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
OP
|
$7,236.90
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,033.24 |
| Max. Negotiated Rate |
$6,513.21 |
| Rate for Payer: Aetna Commercial |
$6,151.36
|
| Rate for Payer: Aetna Medicare |
$1,881.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,261.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,261.53
|
| Rate for Payer: BCBS Complete |
$1,084.97
|
| Rate for Payer: BCBS MAPPO |
$1,809.22
|
| Rate for Payer: BCBS Trust/PPO |
$5,949.46
|
| Rate for Payer: BCN Commercial |
$5,626.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,809.22
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cofinity Commercial |
$6,223.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,789.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,809.22
|
| Rate for Payer: Healthscope Commercial |
$6,513.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,427.68
|
| Rate for Payer: Mclaren Medicaid |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,899.69
|
| Rate for Payer: Meridian Medicaid |
$1,084.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,080.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,151.36
|
| Rate for Payer: Nomi Health Commercial |
$5,934.26
|
| Rate for Payer: PACE Senior Care Partners |
$1,718.76
|
| Rate for Payer: PACE SWMI |
$1,809.22
|
| Rate for Payer: PHP Commercial |
$6,151.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,809.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,033.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,703.98
|
| Rate for Payer: Priority Health HMO/PPO |
$6,296.10
|
| Rate for Payer: Priority Health Medicare |
$1,827.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,848.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,809.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,368.47
|
| Rate for Payer: UHC Core |
$6,042.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,809.22
|
| Rate for Payer: UHC Exchange |
$1,809.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,809.22
|
| Rate for Payer: UHCCP Medicaid |
$1,033.24
|
| Rate for Payer: VA VA |
$1,809.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,427.68
|
|
