|
HC CT ABLATION PROCEDURE
|
Facility
|
OP
|
$1,097.42
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$406.05 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna American Axle |
$713.32
|
| Rate for Payer: Aetna Commercial |
$932.81
|
| Rate for Payer: Aetna Medicare |
$548.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$713.32
|
| Rate for Payer: BCBS Complete |
$438.97
|
| Rate for Payer: Cash Price |
$877.94
|
| Rate for Payer: Cash Price |
$877.94
|
| Rate for Payer: Cofinity Commercial |
$943.78
|
| Rate for Payer: Cofinity Commercial |
$768.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$768.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.94
|
| Rate for Payer: Healthscope Commercial |
$987.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$768.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$823.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$932.81
|
| Rate for Payer: PHP Commercial |
$932.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.32
|
| Rate for Payer: Priority Health SBD |
$691.37
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UMR Bronson Commercial |
$406.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$823.07
|
|
|
HC CT ABLATION PROCEDURE
|
Facility
|
IP
|
$1,097.42
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$482.86 |
| Max. Negotiated Rate |
$987.68 |
| Rate for Payer: Aetna American Axle |
$713.32
|
| Rate for Payer: Aetna Commercial |
$932.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$713.32
|
| Rate for Payer: Cash Price |
$877.94
|
| Rate for Payer: Cofinity Commercial |
$768.19
|
| Rate for Payer: Cofinity Commercial |
$943.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$768.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.94
|
| Rate for Payer: Healthscope Commercial |
$987.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$768.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$823.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$932.81
|
| Rate for Payer: PHP Commercial |
$932.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.32
|
| Rate for Payer: Priority Health SBD |
$691.37
|
| Rate for Payer: UMR Bronson Commercial |
$482.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$823.07
|
|
|
HC CT ANGIO ABD AND PELVIS
|
Facility
|
IP
|
$3,085.62
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,357.67 |
| Max. Negotiated Rate |
$2,777.06 |
| Rate for Payer: Aetna American Axle |
$2,005.65
|
| Rate for Payer: Aetna Commercial |
$2,622.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,005.65
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cofinity Commercial |
$2,159.93
|
| Rate for Payer: Cofinity Commercial |
$2,653.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,159.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,468.50
|
| Rate for Payer: Healthscope Commercial |
$2,777.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,159.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,314.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,622.78
|
| Rate for Payer: PHP Commercial |
$2,622.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,005.65
|
| Rate for Payer: Priority Health SBD |
$1,943.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,357.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,314.22
|
|
|
HC CT ANGIO ABD AND PELVIS
|
Facility
|
OP
|
$3,085.62
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,777.06 |
| Rate for Payer: Aetna American Axle |
$2,005.65
|
| Rate for Payer: Aetna Commercial |
$2,622.78
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,005.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cofinity Commercial |
$2,653.63
|
| Rate for Payer: Cofinity Commercial |
$2,159.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,159.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,468.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,777.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,159.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,314.22
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,622.78
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$2,622.78
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,005.65
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$1,943.94
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$665.64
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,141.68
|
| Rate for Payer: VA VA |
$348.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,314.22
|
|
|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
IP
|
$1,316.94
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$579.45 |
| Max. Negotiated Rate |
$1,185.25 |
| Rate for Payer: Aetna American Axle |
$856.01
|
| Rate for Payer: Aetna Commercial |
$1,119.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$856.01
|
| Rate for Payer: Cash Price |
$1,053.55
|
| Rate for Payer: Cofinity Commercial |
$1,132.57
|
| Rate for Payer: Cofinity Commercial |
$921.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$921.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,053.55
|
| Rate for Payer: Healthscope Commercial |
$1,185.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$921.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$987.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,119.40
|
| Rate for Payer: PHP Commercial |
$1,119.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.01
|
| Rate for Payer: Priority Health SBD |
$829.67
|
| Rate for Payer: UMR Bronson Commercial |
$579.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$987.71
|
|
|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
OP
|
$1,316.94
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$1,185.25 |
| Rate for Payer: Aetna American Axle |
$856.01
|
| Rate for Payer: Aetna Commercial |
$1,119.40
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$856.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,053.55
|
| Rate for Payer: Cash Price |
$1,053.55
|
| Rate for Payer: Cofinity Commercial |
$921.86
|
| Rate for Payer: Cofinity Commercial |
$1,132.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$921.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,053.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,185.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$921.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$987.71
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,119.40
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,119.40
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.01
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$829.67
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$665.64
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: UMR Bronson Commercial |
$487.27
|
| Rate for Payer: VA VA |
$348.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$987.71
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
IP
|
$2,156.43
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$948.83 |
| Max. Negotiated Rate |
$1,940.79 |
| Rate for Payer: Aetna American Axle |
$1,401.68
|
| Rate for Payer: Aetna Commercial |
$1,832.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,401.68
|
| Rate for Payer: Cash Price |
$1,725.14
|
| Rate for Payer: Cofinity Commercial |
$1,509.50
|
| Rate for Payer: Cofinity Commercial |
$1,854.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,509.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.14
|
| Rate for Payer: Healthscope Commercial |
$1,940.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,509.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,617.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,832.97
|
| Rate for Payer: PHP Commercial |
$1,832.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.68
|
| Rate for Payer: Priority Health SBD |
$1,358.55
|
| Rate for Payer: UMR Bronson Commercial |
$948.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,617.32
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
OP
|
$2,156.43
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,940.79 |
| Rate for Payer: Aetna American Axle |
$1,401.68
|
| Rate for Payer: Aetna Commercial |
$1,832.97
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,401.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,725.14
|
| Rate for Payer: Cash Price |
$1,725.14
|
| Rate for Payer: Cofinity Commercial |
$1,854.53
|
| Rate for Payer: Cofinity Commercial |
$1,509.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,509.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,940.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,509.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,617.32
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,832.97
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,832.97
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.68
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$1,358.55
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$331.81
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: UMR Bronson Commercial |
$797.88
|
| Rate for Payer: VA VA |
$173.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,617.32
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
OP
|
$691.71
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$622.54 |
| Rate for Payer: Aetna American Axle |
$449.61
|
| Rate for Payer: Aetna Commercial |
$587.95
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$553.37
|
| Rate for Payer: Cash Price |
$553.37
|
| Rate for Payer: Cofinity Commercial |
$594.87
|
| Rate for Payer: Cofinity Commercial |
$484.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$622.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$484.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.78
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.95
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$587.95
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.61
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$435.78
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$255.93
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.78
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
IP
|
$691.71
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$304.35 |
| Max. Negotiated Rate |
$622.54 |
| Rate for Payer: Aetna American Axle |
$449.61
|
| Rate for Payer: Aetna Commercial |
$587.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.61
|
| Rate for Payer: Cash Price |
$553.37
|
| Rate for Payer: Cofinity Commercial |
$484.20
|
| Rate for Payer: Cofinity Commercial |
$594.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.37
|
| Rate for Payer: Healthscope Commercial |
$622.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$484.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.95
|
| Rate for Payer: PHP Commercial |
$587.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.61
|
| Rate for Payer: Priority Health SBD |
$435.78
|
| Rate for Payer: UMR Bronson Commercial |
$304.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.78
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
OP
|
$1,052.05
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$389.26 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna American Axle |
$683.83
|
| Rate for Payer: Aetna Commercial |
$894.24
|
| Rate for Payer: Aetna Medicare |
$526.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.83
|
| Rate for Payer: BCBS Complete |
$420.82
|
| Rate for Payer: Cash Price |
$841.64
|
| Rate for Payer: Cash Price |
$841.64
|
| Rate for Payer: Cofinity Commercial |
$904.76
|
| Rate for Payer: Cofinity Commercial |
$736.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$736.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.64
|
| Rate for Payer: Healthscope Commercial |
$946.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$736.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$789.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.24
|
| Rate for Payer: PHP Commercial |
$894.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.83
|
| Rate for Payer: Priority Health SBD |
$662.79
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UMR Bronson Commercial |
$389.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$789.04
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
IP
|
$1,052.05
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$462.90 |
| Max. Negotiated Rate |
$946.85 |
| Rate for Payer: Aetna American Axle |
$683.83
|
| Rate for Payer: Aetna Commercial |
$894.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.83
|
| Rate for Payer: Cash Price |
$841.64
|
| Rate for Payer: Cofinity Commercial |
$736.43
|
| Rate for Payer: Cofinity Commercial |
$904.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$736.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.64
|
| Rate for Payer: Healthscope Commercial |
$946.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$736.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$789.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.24
|
| Rate for Payer: PHP Commercial |
$894.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.83
|
| Rate for Payer: Priority Health SBD |
$662.79
|
| Rate for Payer: UMR Bronson Commercial |
$462.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$789.04
|
|
|
HC CT BRAIN W CON
|
Facility
|
OP
|
$1,622.71
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,460.44 |
| Rate for Payer: Aetna American Axle |
$1,054.76
|
| Rate for Payer: Aetna Commercial |
$1,379.30
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,054.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,298.17
|
| Rate for Payer: Cash Price |
$1,298.17
|
| Rate for Payer: Cofinity Commercial |
$1,395.53
|
| Rate for Payer: Cofinity Commercial |
$1,135.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,135.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,298.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,460.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,135.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,217.03
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,379.30
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,379.30
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.76
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$1,022.31
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$331.81
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: UMR Bronson Commercial |
$600.40
|
| Rate for Payer: VA VA |
$173.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,217.03
|
|
|
HC CT BRAIN W CON
|
Facility
|
IP
|
$1,622.71
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$713.99 |
| Max. Negotiated Rate |
$1,460.44 |
| Rate for Payer: Aetna American Axle |
$1,054.76
|
| Rate for Payer: Aetna Commercial |
$1,379.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,054.76
|
| Rate for Payer: Cash Price |
$1,298.17
|
| Rate for Payer: Cofinity Commercial |
$1,135.90
|
| Rate for Payer: Cofinity Commercial |
$1,395.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,135.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,298.17
|
| Rate for Payer: Healthscope Commercial |
$1,460.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,135.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,217.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,379.30
|
| Rate for Payer: PHP Commercial |
$1,379.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.76
|
| Rate for Payer: Priority Health SBD |
$1,022.31
|
| Rate for Payer: UMR Bronson Commercial |
$713.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,217.03
|
|
|
HC CT BRAIN WO CON
|
Facility
|
OP
|
$1,514.14
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,362.73 |
| Rate for Payer: Aetna American Axle |
$984.19
|
| Rate for Payer: Aetna Commercial |
$1,287.02
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$1,211.31
|
| Rate for Payer: Cash Price |
$1,211.31
|
| Rate for Payer: Cofinity Commercial |
$1,302.16
|
| Rate for Payer: Cofinity Commercial |
$1,059.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,059.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,211.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,362.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,059.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,135.61
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,287.02
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$1,287.02
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.19
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$953.91
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$560.23
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,135.61
|
|
|
HC CT BRAIN WO CON
|
Facility
|
IP
|
$1,514.14
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$666.22 |
| Max. Negotiated Rate |
$1,362.73 |
| Rate for Payer: Aetna American Axle |
$984.19
|
| Rate for Payer: Aetna Commercial |
$1,287.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.19
|
| Rate for Payer: Cash Price |
$1,211.31
|
| Rate for Payer: Cofinity Commercial |
$1,059.90
|
| Rate for Payer: Cofinity Commercial |
$1,302.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,059.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,211.31
|
| Rate for Payer: Healthscope Commercial |
$1,362.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,059.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,135.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,287.02
|
| Rate for Payer: PHP Commercial |
$1,287.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.19
|
| Rate for Payer: Priority Health SBD |
$953.91
|
| Rate for Payer: UMR Bronson Commercial |
$666.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,135.61
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
OP
|
$1,825.90
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,643.31 |
| Rate for Payer: Aetna American Axle |
$1,186.84
|
| Rate for Payer: Aetna Commercial |
$1,552.02
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,186.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,460.72
|
| Rate for Payer: Cash Price |
$1,460.72
|
| Rate for Payer: Cofinity Commercial |
$1,570.27
|
| Rate for Payer: Cofinity Commercial |
$1,278.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,278.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,460.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,643.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,278.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,369.42
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,552.02
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,552.02
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.84
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$1,150.32
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$331.81
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: UMR Bronson Commercial |
$675.58
|
| Rate for Payer: VA VA |
$173.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,369.42
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
IP
|
$1,825.90
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$803.40 |
| Max. Negotiated Rate |
$1,643.31 |
| Rate for Payer: Aetna American Axle |
$1,186.84
|
| Rate for Payer: Aetna Commercial |
$1,552.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,186.84
|
| Rate for Payer: Cash Price |
$1,460.72
|
| Rate for Payer: Cofinity Commercial |
$1,278.13
|
| Rate for Payer: Cofinity Commercial |
$1,570.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,278.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,460.72
|
| Rate for Payer: Healthscope Commercial |
$1,643.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,278.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,369.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,552.02
|
| Rate for Payer: PHP Commercial |
$1,552.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.84
|
| Rate for Payer: Priority Health SBD |
$1,150.32
|
| Rate for Payer: UMR Bronson Commercial |
$803.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,369.42
|
|
|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
OP
|
$2,068.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,861.20 |
| Rate for Payer: Aetna American Axle |
$1,344.20
|
| Rate for Payer: Aetna Commercial |
$1,757.80
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Cofinity Commercial |
$1,778.48
|
| Rate for Payer: Cofinity Commercial |
$1,447.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,447.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,654.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,861.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,447.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,551.00
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.80
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,757.80
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.20
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$1,302.84
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$331.81
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: UMR Bronson Commercial |
$765.16
|
| Rate for Payer: VA VA |
$173.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,551.00
|
|
|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
IP
|
$2,068.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$909.92 |
| Max. Negotiated Rate |
$1,861.20 |
| Rate for Payer: Aetna American Axle |
$1,344.20
|
| Rate for Payer: Aetna Commercial |
$1,757.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.20
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Cofinity Commercial |
$1,447.60
|
| Rate for Payer: Cofinity Commercial |
$1,778.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,447.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,654.40
|
| Rate for Payer: Healthscope Commercial |
$1,861.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,447.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,551.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.80
|
| Rate for Payer: PHP Commercial |
$1,757.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.20
|
| Rate for Payer: Priority Health SBD |
$1,302.84
|
| Rate for Payer: UMR Bronson Commercial |
$909.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,551.00
|
|
|
HC CT CHEST SCREENING LUNG CANCER
|
Facility
|
IP
|
$505.03
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$222.21 |
| Max. Negotiated Rate |
$454.53 |
| Rate for Payer: Aetna American Axle |
$328.27
|
| Rate for Payer: Aetna Commercial |
$429.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.27
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cofinity Commercial |
$353.52
|
| Rate for Payer: Cofinity Commercial |
$434.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.02
|
| Rate for Payer: Healthscope Commercial |
$454.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.28
|
| Rate for Payer: PHP Commercial |
$429.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.27
|
| Rate for Payer: Priority Health SBD |
$318.17
|
| Rate for Payer: UMR Bronson Commercial |
$222.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.77
|
|
|
HC CT CHEST SCREENING LUNG CANCER
|
Facility
|
OP
|
$505.03
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna American Axle |
$328.27
|
| Rate for Payer: Aetna Commercial |
$429.28
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cofinity Commercial |
$434.33
|
| Rate for Payer: Cofinity Commercial |
$353.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$454.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.77
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.28
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$429.28
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.27
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$318.17
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$186.86
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.77
|
|
|
HC CT CHEST WITH CON
|
Facility
|
OP
|
$1,737.15
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,563.43 |
| Rate for Payer: Aetna American Axle |
$1,129.15
|
| Rate for Payer: Aetna Commercial |
$1,476.58
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,389.72
|
| Rate for Payer: Cash Price |
$1,389.72
|
| Rate for Payer: Cofinity Commercial |
$1,493.95
|
| Rate for Payer: Cofinity Commercial |
$1,216.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,216.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,389.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,563.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,216.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,302.86
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.58
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,476.58
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.15
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$1,094.40
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$331.81
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: UMR Bronson Commercial |
$642.75
|
| Rate for Payer: VA VA |
$173.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,302.86
|
|
|
HC CT CHEST WITH CON
|
Facility
|
IP
|
$1,737.15
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$764.35 |
| Max. Negotiated Rate |
$1,563.43 |
| Rate for Payer: Aetna American Axle |
$1,129.15
|
| Rate for Payer: Aetna Commercial |
$1,476.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.15
|
| Rate for Payer: Cash Price |
$1,389.72
|
| Rate for Payer: Cofinity Commercial |
$1,216.01
|
| Rate for Payer: Cofinity Commercial |
$1,493.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,216.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,389.72
|
| Rate for Payer: Healthscope Commercial |
$1,563.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,216.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,302.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.58
|
| Rate for Payer: PHP Commercial |
$1,476.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.15
|
| Rate for Payer: Priority Health SBD |
$1,094.40
|
| Rate for Payer: UMR Bronson Commercial |
$764.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,302.86
|
|
|
HC CT CHEST WO CON
|
Facility
|
IP
|
$1,514.09
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$666.20 |
| Max. Negotiated Rate |
$1,362.68 |
| Rate for Payer: Aetna American Axle |
$984.16
|
| Rate for Payer: Aetna Commercial |
$1,286.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.16
|
| Rate for Payer: Cash Price |
$1,211.27
|
| Rate for Payer: Cofinity Commercial |
$1,059.86
|
| Rate for Payer: Cofinity Commercial |
$1,302.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,059.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,211.27
|
| Rate for Payer: Healthscope Commercial |
$1,362.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,059.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,135.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,286.98
|
| Rate for Payer: PHP Commercial |
$1,286.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.16
|
| Rate for Payer: Priority Health SBD |
$953.88
|
| Rate for Payer: UMR Bronson Commercial |
$666.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,135.57
|
|
