|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100148
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$22,000.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna American Axle |
$32,500.00
|
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,500.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Advantage |
$35,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,000.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,500.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: Priority Health SBD |
$31,500.00
|
| Rate for Payer: UMR Bronson Commercial |
$22,000.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,500.00
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100148
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna American Axle |
$32,500.00
|
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,500.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$10,509.43
|
| Rate for Payer: BCN Commercial |
$10,509.43
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Advantage |
$35,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,000.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,500.00
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$31,500.00
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: UMR Bronson Commercial |
$18,500.00
|
| Rate for Payer: VA VA |
$11,502.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,500.00
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE & RETROGRADE
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT 92945
|
| Hospital Charge Code |
48100151
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna American Axle |
$32,500.00
|
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,500.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Advantage |
$35,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,000.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,500.00
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$31,500.00
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: UMR Bronson Commercial |
$18,500.00
|
| Rate for Payer: VA VA |
$11,502.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,500.00
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE & RETROGRADE
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT 92945
|
| Hospital Charge Code |
48100151
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$22,000.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Aetna American Axle |
$32,500.00
|
| Rate for Payer: Aetna Commercial |
$42,500.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,500.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Advantage |
$35,000.00
|
| Rate for Payer: Cofinity Commercial |
$43,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$45,000.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35,000.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,500.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PHP Commercial |
$42,500.00
|
| Rate for Payer: Priority Health SBD |
$31,500.00
|
| Rate for Payer: UMR Bronson Commercial |
$22,000.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,500.00
|
|
|
HC PERQ TRANSLUM ATHERECTOMY ARTERY/BRANCHES
|
Facility
|
IP
|
$28,200.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100142
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,408.00 |
| Max. Negotiated Rate |
$25,380.00 |
| Rate for Payer: Aetna American Axle |
$18,330.00
|
| Rate for Payer: Aetna Commercial |
$23,970.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,330.00
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cofinity Advantage |
$19,740.00
|
| Rate for Payer: Cofinity Commercial |
$24,252.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,560.00
|
| Rate for Payer: Healthscope Commercial |
$25,380.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,740.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,970.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,150.00
|
| Rate for Payer: PHP Commercial |
$23,970.00
|
| Rate for Payer: Priority Health SBD |
$17,766.00
|
| Rate for Payer: UMR Bronson Commercial |
$12,408.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,150.00
|
|
|
HC PERQ TRANSLUM ATHERECTOMY ARTERY/BRANCHES
|
Facility
|
OP
|
$28,200.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100142
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$293.72 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna American Axle |
$18,330.00
|
| Rate for Payer: Aetna Commercial |
$23,970.00
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,330.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$293.72
|
| Rate for Payer: BCN Commercial |
$293.72
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cofinity Advantage |
$19,740.00
|
| Rate for Payer: Cofinity Commercial |
$24,252.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$25,380.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,740.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,150.00
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,970.00
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,150.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$23,970.00
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$17,766.00
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: UMR Bronson Commercial |
$10,434.00
|
| Rate for Payer: VA VA |
$11,502.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,150.00
|
|
|
HC PERQ TRANSLUM BALLOON ANGIO ARTERY/BRANCHES
|
Facility
|
OP
|
$18,900.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,965.99 |
| Max. Negotiated Rate |
$18,339.80 |
| Rate for Payer: Aetna American Axle |
$12,285.00
|
| Rate for Payer: Aetna Commercial |
$16,065.00
|
| Rate for Payer: Aetna Medicare |
$5,897.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,285.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,088.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,088.88
|
| Rate for Payer: BCBS Complete |
$3,114.57
|
| Rate for Payer: BCBS MAPPO |
$5,671.10
|
| Rate for Payer: BCBS Trust/PPO |
$6,096.33
|
| Rate for Payer: BCN Commercial |
$6,096.33
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.10
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cofinity Advantage |
$13,230.00
|
| Rate for Payer: Cofinity Commercial |
$16,254.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.10
|
| Rate for Payer: Healthscope Commercial |
$17,010.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,230.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,175.00
|
| Rate for Payer: Mclaren Medicaid |
$5,671.10
|
| Rate for Payer: Mclaren Medicare |
$5,671.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,954.65
|
| Rate for Payer: Meridian Medicaid |
$5,954.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,521.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,238.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,065.00
|
| Rate for Payer: Nomi Health Commercial |
$17,013.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,175.00
|
| Rate for Payer: PACE Medicare |
$5,387.55
|
| Rate for Payer: PACE SWMI |
$5,671.10
|
| Rate for Payer: PHP Commercial |
$16,065.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,965.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,339.80
|
| Rate for Payer: Priority Health Medicare |
$5,671.10
|
| Rate for Payer: Priority Health SBD |
$11,907.00
|
| Rate for Payer: Priority Health Tiered Network |
$14,671.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,671.10
|
| Rate for Payer: UHC Medicaid |
$2,965.99
|
| Rate for Payer: UHCCP Medicaid |
$2,965.99
|
| Rate for Payer: UMR Bronson Commercial |
$6,993.00
|
| Rate for Payer: VA VA |
$5,671.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,175.00
|
|
|
HC PERQ TRANSLUM BALLOON ANGIO ARTERY/BRANCHES
|
Facility
|
IP
|
$18,900.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,316.00 |
| Max. Negotiated Rate |
$17,010.00 |
| Rate for Payer: Aetna American Axle |
$12,285.00
|
| Rate for Payer: Aetna Commercial |
$16,065.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,285.00
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cofinity Advantage |
$13,230.00
|
| Rate for Payer: Cofinity Commercial |
$16,254.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,120.00
|
| Rate for Payer: Healthscope Commercial |
$17,010.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,230.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,175.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,065.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,175.00
|
| Rate for Payer: PHP Commercial |
$16,065.00
|
| Rate for Payer: Priority Health SBD |
$11,907.00
|
| Rate for Payer: UMR Bronson Commercial |
$8,316.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,175.00
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
IP
|
$16,011.14
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,044.90 |
| Max. Negotiated Rate |
$14,410.03 |
| Rate for Payer: Aetna American Axle |
$10,407.24
|
| Rate for Payer: Aetna Commercial |
$13,609.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,407.24
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cofinity Advantage |
$11,207.80
|
| Rate for Payer: Cofinity Commercial |
$13,769.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,808.91
|
| Rate for Payer: Healthscope Commercial |
$14,410.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,207.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,008.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,609.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,008.35
|
| Rate for Payer: PHP Commercial |
$13,609.47
|
| Rate for Payer: Priority Health SBD |
$10,087.02
|
| Rate for Payer: UMR Bronson Commercial |
$7,044.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,008.35
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
OP
|
$16,011.14
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$293.72 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna American Axle |
$10,407.24
|
| Rate for Payer: Aetna Commercial |
$13,609.47
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,407.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$293.72
|
| Rate for Payer: BCN Commercial |
$293.72
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cofinity Advantage |
$11,207.80
|
| Rate for Payer: Cofinity Commercial |
$13,769.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,808.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$14,410.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,207.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,008.35
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,609.47
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,008.35
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$13,609.47
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$10,087.02
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: UMR Bronson Commercial |
$5,924.12
|
| Rate for Payer: VA VA |
$11,502.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,008.35
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
OP
|
$17,328.78
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,411.65 |
| Max. Negotiated Rate |
$15,595.90 |
| Rate for Payer: Aetna American Axle |
$11,263.71
|
| Rate for Payer: Aetna Commercial |
$14,729.46
|
| Rate for Payer: Aetna Medicare |
$8,664.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,263.71
|
| Rate for Payer: BCBS Complete |
$6,931.51
|
| Rate for Payer: Cash Price |
$13,863.02
|
| Rate for Payer: Cofinity Advantage |
$12,130.15
|
| Rate for Payer: Cofinity Commercial |
$14,902.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,863.02
|
| Rate for Payer: Healthscope Commercial |
$15,595.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,130.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,996.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,863.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,729.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,996.58
|
| Rate for Payer: PHP Commercial |
$14,729.46
|
| Rate for Payer: Priority Health SBD |
$10,917.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,263.71
|
| Rate for Payer: UHC Core |
$9,028.29
|
| Rate for Payer: UHC Exchange |
$6,810.21
|
| Rate for Payer: UMR Bronson Commercial |
$6,411.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,996.58
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
IP
|
$17,328.78
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,624.66 |
| Max. Negotiated Rate |
$15,595.90 |
| Rate for Payer: Aetna American Axle |
$11,263.71
|
| Rate for Payer: Aetna Commercial |
$14,729.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,263.71
|
| Rate for Payer: Cash Price |
$13,863.02
|
| Rate for Payer: Cofinity Advantage |
$12,130.15
|
| Rate for Payer: Cofinity Commercial |
$14,902.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,863.02
|
| Rate for Payer: Healthscope Commercial |
$15,595.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,130.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,996.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,729.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,996.58
|
| Rate for Payer: PHP Commercial |
$14,729.46
|
| Rate for Payer: Priority Health SBD |
$10,917.13
|
| Rate for Payer: UMR Bronson Commercial |
$7,624.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,996.58
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
OP
|
$87.55
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$188.21 |
| Rate for Payer: Aetna American Axle |
$56.91
|
| Rate for Payer: Aetna Commercial |
$74.42
|
| Rate for Payer: Aetna Medicare |
$43.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.91
|
| Rate for Payer: BCBS Complete |
$35.02
|
| Rate for Payer: BCBS Trust/PPO |
$188.21
|
| Rate for Payer: BCN Commercial |
$188.21
|
| Rate for Payer: Cash Price |
$70.04
|
| Rate for Payer: Cash Price |
$70.04
|
| Rate for Payer: Cofinity Advantage |
$61.28
|
| Rate for Payer: Cofinity Commercial |
$75.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.04
|
| Rate for Payer: Healthscope Commercial |
$78.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.66
|
| Rate for Payer: PHP Commercial |
$74.42
|
| Rate for Payer: Priority Health SBD |
$55.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.91
|
| Rate for Payer: UHC Core |
$45.61
|
| Rate for Payer: UHC Exchange |
$34.41
|
| Rate for Payer: UMR Bronson Commercial |
$32.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.66
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
IP
|
$87.55
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.52 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Aetna American Axle |
$56.91
|
| Rate for Payer: Aetna Commercial |
$74.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.91
|
| Rate for Payer: Cash Price |
$70.04
|
| Rate for Payer: Cofinity Advantage |
$61.28
|
| Rate for Payer: Cofinity Commercial |
$75.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.04
|
| Rate for Payer: Healthscope Commercial |
$78.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.66
|
| Rate for Payer: PHP Commercial |
$74.42
|
| Rate for Payer: Priority Health SBD |
$55.16
|
| Rate for Payer: UMR Bronson Commercial |
$38.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.66
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
OP
|
$200.57
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.21 |
| Max. Negotiated Rate |
$180.51 |
| Rate for Payer: Aetna American Axle |
$130.37
|
| Rate for Payer: Aetna Commercial |
$170.48
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.37
|
| Rate for Payer: BCBS Complete |
$80.23
|
| Rate for Payer: BCBS Trust/PPO |
$75.76
|
| Rate for Payer: BCN Commercial |
$75.76
|
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Cofinity Advantage |
$140.40
|
| Rate for Payer: Cofinity Commercial |
$172.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.46
|
| Rate for Payer: Healthscope Commercial |
$180.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.43
|
| Rate for Payer: PHP Commercial |
$170.48
|
| Rate for Payer: Priority Health SBD |
$126.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.37
|
| Rate for Payer: UHC Core |
$104.50
|
| Rate for Payer: UHC Exchange |
$78.82
|
| Rate for Payer: UMR Bronson Commercial |
$74.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.43
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
IP
|
$200.57
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.25 |
| Max. Negotiated Rate |
$180.51 |
| Rate for Payer: Aetna American Axle |
$130.37
|
| Rate for Payer: Aetna Commercial |
$170.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.37
|
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Cofinity Advantage |
$140.40
|
| Rate for Payer: Cofinity Commercial |
$172.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.46
|
| Rate for Payer: Healthscope Commercial |
$180.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.43
|
| Rate for Payer: PHP Commercial |
$170.48
|
| Rate for Payer: Priority Health SBD |
$126.36
|
| Rate for Payer: UMR Bronson Commercial |
$88.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.43
|
|
|
HC PET AQMBF REST AND PHARM STRESS
|
Facility
|
IP
|
$5,342.76
|
|
|
Service Code
|
CPT 78434
|
| Hospital Charge Code |
40400013
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,350.81 |
| Max. Negotiated Rate |
$4,808.48 |
| Rate for Payer: Aetna American Axle |
$3,472.79
|
| Rate for Payer: Aetna Commercial |
$4,541.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,472.79
|
| Rate for Payer: Cash Price |
$4,274.21
|
| Rate for Payer: Cofinity Advantage |
$3,739.93
|
| Rate for Payer: Cofinity Commercial |
$4,594.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,274.21
|
| Rate for Payer: Healthscope Commercial |
$4,808.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,739.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,007.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,541.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,007.07
|
| Rate for Payer: PHP Commercial |
$4,541.35
|
| Rate for Payer: Priority Health SBD |
$3,365.94
|
| Rate for Payer: UMR Bronson Commercial |
$2,350.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,007.07
|
|
|
HC PET AQMBF REST AND PHARM STRESS
|
Facility
|
OP
|
$5,342.76
|
|
|
Service Code
|
CPT 78434
|
| Hospital Charge Code |
40400013
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,976.82 |
| Max. Negotiated Rate |
$4,808.48 |
| Rate for Payer: Aetna American Axle |
$3,472.79
|
| Rate for Payer: Aetna Commercial |
$4,541.35
|
| Rate for Payer: Aetna Medicare |
$2,671.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,472.79
|
| Rate for Payer: BCBS Complete |
$2,137.10
|
| Rate for Payer: Cash Price |
$4,274.21
|
| Rate for Payer: Cofinity Advantage |
$3,739.93
|
| Rate for Payer: Cofinity Commercial |
$4,594.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,274.21
|
| Rate for Payer: Healthscope Commercial |
$4,808.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,739.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,007.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,274.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,541.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,007.07
|
| Rate for Payer: PHP Commercial |
$4,541.35
|
| Rate for Payer: Priority Health SBD |
$3,365.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,472.79
|
| Rate for Payer: UHC Core |
$2,783.58
|
| Rate for Payer: UHC Exchange |
$2,099.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,976.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,007.07
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
OP
|
$5,417.04
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$4,875.34 |
| Rate for Payer: Aetna American Axle |
$3,521.08
|
| Rate for Payer: Aetna Commercial |
$4,604.48
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,521.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,248.12
|
| Rate for Payer: BCN Commercial |
$2,248.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,333.63
|
| Rate for Payer: Cash Price |
$4,333.63
|
| Rate for Payer: Cofinity Advantage |
$3,791.93
|
| Rate for Payer: Cofinity Commercial |
$4,658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,333.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$4,875.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,791.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,062.78
|
| Rate for Payer: Mclaren Medicaid |
$1,424.81
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$1,496.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,604.48
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,062.78
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$4,604.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,607.70
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health SBD |
$3,412.74
|
| Rate for Payer: Priority Health Tiered Network |
$3,686.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,521.08
|
| Rate for Payer: UHC Core |
$2,822.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,128.90
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,004.30
|
| Rate for Payer: VA VA |
$1,424.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,062.78
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
IP
|
$5,417.04
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,383.50 |
| Max. Negotiated Rate |
$4,875.34 |
| Rate for Payer: Aetna American Axle |
$3,521.08
|
| Rate for Payer: Aetna Commercial |
$4,604.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,521.08
|
| Rate for Payer: Cash Price |
$4,333.63
|
| Rate for Payer: Cofinity Advantage |
$3,791.93
|
| Rate for Payer: Cofinity Commercial |
$4,658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,333.63
|
| Rate for Payer: Healthscope Commercial |
$4,875.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,791.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,062.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,604.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,062.78
|
| Rate for Payer: PHP Commercial |
$4,604.48
|
| Rate for Payer: Priority Health SBD |
$3,412.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,383.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,062.78
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
IP
|
$6,017.05
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,647.50 |
| Max. Negotiated Rate |
$5,415.35 |
| Rate for Payer: Aetna American Axle |
$3,911.08
|
| Rate for Payer: Aetna Commercial |
$5,114.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,911.08
|
| Rate for Payer: Cash Price |
$4,813.64
|
| Rate for Payer: Cofinity Advantage |
$4,211.94
|
| Rate for Payer: Cofinity Commercial |
$5,174.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.64
|
| Rate for Payer: Healthscope Commercial |
$5,415.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,211.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,512.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,512.79
|
| Rate for Payer: PHP Commercial |
$5,114.49
|
| Rate for Payer: Priority Health SBD |
$3,790.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,647.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,512.79
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
OP
|
$6,017.05
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,415.35 |
| Rate for Payer: Aetna American Axle |
$3,911.08
|
| Rate for Payer: Aetna Commercial |
$5,114.49
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,911.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,248.12
|
| Rate for Payer: BCN Commercial |
$2,248.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,813.64
|
| Rate for Payer: Cash Price |
$4,813.64
|
| Rate for Payer: Cofinity Advantage |
$4,211.94
|
| Rate for Payer: Cofinity Commercial |
$5,174.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,415.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,211.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,512.79
|
| Rate for Payer: Mclaren Medicaid |
$1,424.81
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$1,496.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.49
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,512.79
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$5,114.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,607.70
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health SBD |
$3,790.74
|
| Rate for Payer: Priority Health Tiered Network |
$3,686.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,911.08
|
| Rate for Payer: UHC Core |
$3,134.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,364.70
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,226.31
|
| Rate for Payer: VA VA |
$1,424.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,512.79
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna American Axle |
$3,711.05
|
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,711.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,248.12
|
| Rate for Payer: BCN Commercial |
$2,248.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Advantage |
$3,996.51
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,138.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,996.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,281.98
|
| Rate for Payer: Mclaren Medicaid |
$1,424.81
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$1,496.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,281.98
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,607.70
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health SBD |
$3,596.86
|
| Rate for Payer: Priority Health Tiered Network |
$3,686.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,711.05
|
| Rate for Payer: UHC Core |
$2,974.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,243.75
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,112.44
|
| Rate for Payer: VA VA |
$1,424.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,281.98
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,512.09 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna American Axle |
$3,711.05
|
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,711.05
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Advantage |
$3,996.51
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Healthscope Commercial |
$5,138.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,996.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,281.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,281.98
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: Priority Health SBD |
$3,596.86
|
| Rate for Payer: UMR Bronson Commercial |
$2,512.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,281.98
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$5,823.49
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,562.34 |
| Max. Negotiated Rate |
$5,241.14 |
| Rate for Payer: Aetna American Axle |
$3,785.27
|
| Rate for Payer: Aetna Commercial |
$4,949.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,785.27
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Advantage |
$4,076.44
|
| Rate for Payer: Cofinity Commercial |
$5,008.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Healthscope Commercial |
$5,241.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,076.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,367.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,949.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| Rate for Payer: PHP Commercial |
$4,949.97
|
| Rate for Payer: Priority Health SBD |
$3,668.80
|
| Rate for Payer: UMR Bronson Commercial |
$2,562.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,367.62
|
|
