|
HC CT ABDOMEN WO CON
|
Facility
|
OP
|
$1,606.90
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,446.21 |
| Rate for Payer: Aetna American Axle |
$1,044.48
|
| Rate for Payer: Aetna Commercial |
$1,365.86
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$173.10
|
| Rate for Payer: BCN Commercial |
$173.10
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,285.52
|
| Rate for Payer: Cash Price |
$1,285.52
|
| Rate for Payer: Cofinity Commercial |
$1,381.93
|
| Rate for Payer: Cofinity Commercial |
$1,124.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,124.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,446.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,124.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,205.18
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.86
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$1,365.86
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$1,012.35
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.28
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$199.12
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$594.55
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,205.18
|
|
|
HC CT ABDOMEN WO CON
|
Facility
|
IP
|
$1,606.90
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$707.04 |
| Max. Negotiated Rate |
$1,446.21 |
| Rate for Payer: Aetna American Axle |
$1,044.48
|
| Rate for Payer: Aetna Commercial |
$1,365.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.48
|
| Rate for Payer: Cash Price |
$1,285.52
|
| Rate for Payer: Cofinity Commercial |
$1,124.83
|
| Rate for Payer: Cofinity Commercial |
$1,381.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,124.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.52
|
| Rate for Payer: Healthscope Commercial |
$1,446.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,124.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,205.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.86
|
| Rate for Payer: PHP Commercial |
$1,365.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.48
|
| Rate for Payer: Priority Health SBD |
$1,012.35
|
| Rate for Payer: UMR Bronson Commercial |
$707.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,205.18
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
IP
|
$2,453.63
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,079.60 |
| Max. Negotiated Rate |
$2,208.27 |
| Rate for Payer: Aetna American Axle |
$1,594.86
|
| Rate for Payer: Aetna Commercial |
$2,085.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,594.86
|
| Rate for Payer: Cash Price |
$1,962.90
|
| Rate for Payer: Cofinity Commercial |
$1,717.54
|
| Rate for Payer: Cofinity Commercial |
$2,110.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,717.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,962.90
|
| Rate for Payer: Healthscope Commercial |
$2,208.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,717.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,840.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,085.59
|
| Rate for Payer: PHP Commercial |
$2,085.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,594.86
|
| Rate for Payer: Priority Health SBD |
$1,545.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,079.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,840.22
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
OP
|
$2,453.63
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$2,208.27 |
| Rate for Payer: Aetna American Axle |
$1,594.86
|
| Rate for Payer: Aetna Commercial |
$2,085.59
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,594.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$418.03
|
| Rate for Payer: BCN Commercial |
$418.03
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,962.90
|
| Rate for Payer: Cash Price |
$1,962.90
|
| Rate for Payer: Cofinity Commercial |
$2,110.12
|
| Rate for Payer: Cofinity Commercial |
$1,717.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,717.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,962.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$2,208.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,717.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,840.22
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,085.59
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$2,085.59
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,594.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$1,545.79
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.14
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$245.58
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: UMR Bronson Commercial |
$907.84
|
| Rate for Payer: VA VA |
$174.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,840.22
|
|
|
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 |
$823.06
|
| 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 |
$823.06
|
|
|
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: BCBS Trust/PPO |
$622.61
|
| Rate for Payer: BCN Commercial |
$622.61
|
| 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 |
$823.06
|
| 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 |
$823.06
|
|
|
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 |
$187.55 |
| 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 |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,005.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$591.13
|
| Rate for Payer: BCN Commercial |
$591.13
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| 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 |
$349.91
|
| 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 |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,622.78
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,622.78
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,005.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,943.94
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.80
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$357.09
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,141.68
|
| Rate for Payer: VA VA |
$349.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,314.22
|
|
|
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 CORONARY DISCONTINUED
|
Facility
|
OP
|
$1,316.94
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$187.55 |
| 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 |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$856.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$448.83
|
| Rate for Payer: BCN Commercial |
$448.83
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| 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 |
$349.91
|
| 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 |
$987.70
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,119.40
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,119.40
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$829.67
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.96
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$303.60
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: UMR Bronson Commercial |
$487.27
|
| Rate for Payer: VA VA |
$349.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$987.70
|
|
|
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 |
$987.70
|
| 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 |
$987.70
|
|
|
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 |
$93.49 |
| 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 |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,401.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$637.65
|
| Rate for Payer: BCN Commercial |
$637.65
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| 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 |
$174.42
|
| 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 |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,832.97
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$1,832.97
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$1,358.55
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.15
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$385.59
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: UMR Bronson Commercial |
$797.88
|
| Rate for Payer: VA VA |
$174.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,617.32
|
|
|
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 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 BONE LENGTH STUDY
|
Facility
|
OP
|
$691.71
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.58 |
| 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 |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$66.36
|
| Rate for Payer: BCN Commercial |
$66.36
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| 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 |
$104.19
|
| 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 |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.95
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$587.95
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$435.78
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.74
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$41.58
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$255.93
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.78
|
|
|
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 |
$946.84 |
| 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 |
$736.44
|
| Rate for Payer: Cofinity Commercial |
$904.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$736.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.64
|
| Rate for Payer: Healthscope Commercial |
$946.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$736.44
|
| 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 PERFUSION
|
Facility
|
OP
|
$1,052.05
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$301.26 |
| 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: BCBS Trust/PPO |
$301.26
|
| Rate for Payer: BCN Commercial |
$301.26
|
| 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 |
$736.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$736.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.64
|
| Rate for Payer: Healthscope Commercial |
$946.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$736.44
|
| 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 W CON
|
Facility
|
OP
|
$1,622.71
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.49 |
| 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 |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,054.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$203.20
|
| Rate for Payer: BCN Commercial |
$203.20
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| 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 |
$174.42
|
| 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 |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,379.30
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$1,379.30
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$1,022.31
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.91
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$139.92
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: UMR Bronson Commercial |
$600.40
|
| Rate for Payer: VA VA |
$174.42
|
| 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 |
$55.85 |
| 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 |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$141.63
|
| Rate for Payer: BCN Commercial |
$141.63
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| 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 |
$104.19
|
| 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 |
$1,135.60
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,287.02
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$1,287.02
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$953.91
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.16
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$100.15
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$560.23
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,135.60
|
|
|
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 |
$1,135.60
|
| 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 |
$1,135.60
|
|
|
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 BRAIN WO W CON
|
Facility
|
OP
|
$1,825.90
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.49 |
| 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 |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,186.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$242.88
|
| Rate for Payer: BCN Commercial |
$242.88
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| 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 |
$174.42
|
| 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 |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,552.02
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$1,552.02
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$1,150.32
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.15
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$163.77
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: UMR Bronson Commercial |
$675.58
|
| Rate for Payer: VA VA |
$174.42
|
| 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 |
$93.49 |
| 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 |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$418.03
|
| Rate for Payer: BCN Commercial |
$418.03
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| 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 |
$174.42
|
| 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 |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.80
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$1,757.80
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$1,302.84
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.22
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$264.75
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: UMR Bronson Commercial |
$765.16
|
| Rate for Payer: VA VA |
$174.42
|
| 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
|
|
