|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
IP
|
$85.83
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Aetna American Axle |
$55.79
|
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.79
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Commercial |
$60.08
|
| Rate for Payer: Cofinity Commercial |
$73.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$77.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: PHP Commercial |
$72.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.79
|
| Rate for Payer: Priority Health SBD |
$54.07
|
| Rate for Payer: UMR Bronson Commercial |
$37.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.37
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
OP
|
$85.83
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$183.87 |
| Rate for Payer: Aetna American Axle |
$55.79
|
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.79
|
| Rate for Payer: BCBS Complete |
$34.33
|
| Rate for Payer: BCBS Trust/PPO |
$183.87
|
| Rate for Payer: BCN Commercial |
$183.87
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Commercial |
$60.08
|
| Rate for Payer: Cofinity Commercial |
$73.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$77.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: PHP Commercial |
$72.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.79
|
| Rate for Payer: Priority Health SBD |
$54.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.38
|
| Rate for Payer: UHC Exchange |
$69.48
|
| Rate for Payer: UMR Bronson Commercial |
$31.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.37
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
OP
|
$196.64
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna American Axle |
$127.82
|
| Rate for Payer: Aetna Commercial |
$167.14
|
| Rate for Payer: Aetna Medicare |
$98.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: BCBS Complete |
$78.66
|
| Rate for Payer: BCBS Trust/PPO |
$74.02
|
| Rate for Payer: BCN Commercial |
$74.02
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$137.65
|
| Rate for Payer: Cofinity Commercial |
$169.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: PHP Commercial |
$167.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.82
|
| Rate for Payer: Priority Health SBD |
$123.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.56
|
| Rate for Payer: UHC Exchange |
$27.97
|
| Rate for Payer: UMR Bronson Commercial |
$72.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.48
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
IP
|
$196.64
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.52 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna American Axle |
$127.82
|
| Rate for Payer: Aetna Commercial |
$167.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$137.65
|
| Rate for Payer: Cofinity Commercial |
$169.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: PHP Commercial |
$167.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.82
|
| Rate for Payer: Priority Health SBD |
$123.88
|
| Rate for Payer: UMR Bronson Commercial |
$86.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.48
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
IP
|
$5,310.82
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,336.76 |
| Max. Negotiated Rate |
$4,779.74 |
| Rate for Payer: Aetna American Axle |
$3,452.03
|
| Rate for Payer: Aetna Commercial |
$4,514.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,452.03
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cofinity Commercial |
$3,717.57
|
| Rate for Payer: Cofinity Commercial |
$4,567.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,717.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,248.66
|
| Rate for Payer: Healthscope Commercial |
$4,779.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,717.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,983.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,514.20
|
| Rate for Payer: PHP Commercial |
$4,514.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,452.03
|
| Rate for Payer: Priority Health SBD |
$3,345.82
|
| Rate for Payer: UMR Bronson Commercial |
$2,336.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,983.12
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
OP
|
$5,310.82
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$4,779.74 |
| Rate for Payer: Aetna American Axle |
$3,452.03
|
| Rate for Payer: Aetna Commercial |
$4,514.20
|
| Rate for Payer: Aetna Medicare |
$1,486.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,452.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.82
|
| Rate for Payer: BCN Commercial |
$1,914.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cofinity Commercial |
$3,717.57
|
| Rate for Payer: Cofinity Commercial |
$4,567.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,717.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,248.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$4,779.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,717.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,983.12
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,514.20
|
| Rate for Payer: Nomi Health Commercial |
$4,287.30
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$4,514.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,452.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,491.63
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,593.30
|
| Rate for Payer: Priority Health SBD |
$3,345.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,022.77
|
| Rate for Payer: UHC Core |
$3,590.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,731.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,965.00
|
| Rate for Payer: VA VA |
$1,429.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,983.12
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
OP
|
$5,899.07
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$5,309.16 |
| Rate for Payer: Aetna American Axle |
$3,834.40
|
| Rate for Payer: Aetna Commercial |
$5,014.21
|
| Rate for Payer: Aetna Medicare |
$1,486.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,834.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.82
|
| Rate for Payer: BCN Commercial |
$1,914.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cofinity Commercial |
$4,129.35
|
| Rate for Payer: Cofinity Commercial |
$5,073.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,129.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,719.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$5,309.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,129.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,424.30
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,014.21
|
| Rate for Payer: Nomi Health Commercial |
$4,287.30
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$5,014.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,834.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,491.63
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,593.30
|
| Rate for Payer: Priority Health SBD |
$3,716.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,022.77
|
| Rate for Payer: UHC Core |
$3,590.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,731.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,182.66
|
| Rate for Payer: VA VA |
$1,429.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,424.30
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
IP
|
$5,899.07
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,595.59 |
| Max. Negotiated Rate |
$5,309.16 |
| Rate for Payer: Aetna American Axle |
$3,834.40
|
| Rate for Payer: Aetna Commercial |
$5,014.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,834.40
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cofinity Commercial |
$4,129.35
|
| Rate for Payer: Cofinity Commercial |
$5,073.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,129.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,719.26
|
| Rate for Payer: Healthscope Commercial |
$5,309.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,129.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,424.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,014.21
|
| Rate for Payer: PHP Commercial |
$5,014.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,834.40
|
| Rate for Payer: Priority Health SBD |
$3,716.41
|
| Rate for Payer: UMR Bronson Commercial |
$2,595.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,424.30
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
IP
|
$5,597.35
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,462.83 |
| Max. Negotiated Rate |
$5,037.62 |
| Rate for Payer: Aetna American Axle |
$3,638.28
|
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,638.28
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cofinity Commercial |
$3,918.14
|
| Rate for Payer: Cofinity Commercial |
$4,813.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,918.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,477.88
|
| Rate for Payer: Healthscope Commercial |
$5,037.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,918.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,198.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,757.75
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,638.28
|
| Rate for Payer: Priority Health SBD |
$3,526.33
|
| Rate for Payer: UMR Bronson Commercial |
$2,462.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,198.01
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
OP
|
$5,597.35
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$5,037.62 |
| Rate for Payer: Aetna American Axle |
$3,638.28
|
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: Aetna Medicare |
$1,486.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,638.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.82
|
| Rate for Payer: BCN Commercial |
$1,914.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cofinity Commercial |
$3,918.14
|
| Rate for Payer: Cofinity Commercial |
$4,813.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,918.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,477.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$5,037.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,918.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,198.01
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,757.75
|
| Rate for Payer: Nomi Health Commercial |
$4,287.30
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,638.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,491.63
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,593.30
|
| Rate for Payer: Priority Health SBD |
$3,526.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,022.77
|
| Rate for Payer: UHC Core |
$3,590.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,731.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,071.02
|
| Rate for Payer: VA VA |
$1,429.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,198.01
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,512.09 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna American Axle |
$3,711.04
|
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,711.04
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Commercial |
$3,996.51
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,996.51
|
| 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: PHP Commercial |
$4,852.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.04
|
| 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
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Cofinity Commercial |
$3,996.51
|
| Rate for Payer: Aetna American Axle |
$3,711.04
|
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: Aetna Medicare |
$1,486.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,711.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.82
|
| Rate for Payer: BCN Commercial |
$1,914.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,996.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| 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 |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,287.30
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,491.63
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,593.30
|
| Rate for Payer: Priority Health SBD |
$3,596.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,022.77
|
| Rate for Payer: UHC Core |
$3,590.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,731.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,112.44
|
| Rate for Payer: VA VA |
$1,429.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,281.98
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,512.09 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna American Axle |
$3,711.04
|
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,711.04
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Commercial |
$3,996.51
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,996.51
|
| 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: PHP Commercial |
$4,852.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.04
|
| 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 WHOLE BODY
|
Facility
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna American Axle |
$3,711.04
|
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: Aetna Medicare |
$1,486.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,711.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.82
|
| Rate for Payer: BCN Commercial |
$1,914.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Commercial |
$3,996.51
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,996.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| 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 |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,287.30
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,491.63
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,593.30
|
| Rate for Payer: Priority Health SBD |
$3,596.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,022.77
|
| Rate for Payer: UHC Core |
$3,590.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,731.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,112.44
|
| Rate for Payer: VA VA |
$1,429.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,281.98
|
|
|
HC PET LIMITED AREA
|
Facility
|
IP
|
$2,627.28
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,156.00 |
| Max. Negotiated Rate |
$2,364.55 |
| Rate for Payer: Aetna American Axle |
$1,707.73
|
| Rate for Payer: Aetna Commercial |
$2,233.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,707.73
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cofinity Commercial |
$1,839.10
|
| Rate for Payer: Cofinity Commercial |
$2,259.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.82
|
| Rate for Payer: Healthscope Commercial |
$2,364.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.19
|
| Rate for Payer: PHP Commercial |
$2,233.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,707.73
|
| Rate for Payer: Priority Health SBD |
$1,655.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.46
|
|
|
HC PET LIMITED AREA
|
Facility
|
OP
|
$2,627.28
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$685.59 |
| Max. Negotiated Rate |
$4,020.13 |
| Rate for Payer: Aetna American Axle |
$1,707.73
|
| Rate for Payer: Aetna Commercial |
$2,233.19
|
| Rate for Payer: Aetna Medicare |
$1,330.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,707.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,598.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,598.85
|
| Rate for Payer: BCBS Complete |
$719.87
|
| Rate for Payer: BCBS MAPPO |
$1,279.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,737.97
|
| Rate for Payer: BCN Commercial |
$1,737.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,279.08
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cofinity Commercial |
$1,839.10
|
| Rate for Payer: Cofinity Commercial |
$2,259.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,279.08
|
| Rate for Payer: Healthscope Commercial |
$2,364.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.46
|
| Rate for Payer: Mclaren Medicaid |
$685.59
|
| Rate for Payer: Mclaren Medicare |
$1,279.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,343.03
|
| Rate for Payer: Meridian Medicaid |
$719.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,470.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.19
|
| Rate for Payer: Nomi Health Commercial |
$3,837.24
|
| Rate for Payer: PACE Medicare |
$1,215.13
|
| Rate for Payer: PACE SWMI |
$1,279.08
|
| Rate for Payer: PHP Commercial |
$2,233.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,279.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,707.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,020.13
|
| Rate for Payer: Priority Health Medicare |
$1,279.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,216.10
|
| Rate for Payer: Priority Health SBD |
$1,655.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,279.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,600.48
|
| Rate for Payer: UHC Core |
$3,590.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,279.08
|
| Rate for Payer: UHC Exchange |
$2,444.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,279.08
|
| Rate for Payer: UHCCP Medicaid |
$685.59
|
| Rate for Payer: UMR Bronson Commercial |
$972.09
|
| Rate for Payer: VA VA |
$1,279.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.46
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
IP
|
$5,342.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,350.48 |
| Max. Negotiated Rate |
$4,807.80 |
| Rate for Payer: Aetna American Axle |
$3,472.30
|
| Rate for Payer: Aetna Commercial |
$4,540.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,472.30
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cofinity Commercial |
$3,739.40
|
| Rate for Payer: Cofinity Commercial |
$4,594.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,739.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,273.60
|
| Rate for Payer: Healthscope Commercial |
$4,807.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,739.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,006.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,540.70
|
| Rate for Payer: PHP Commercial |
$4,540.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,472.30
|
| Rate for Payer: Priority Health SBD |
$3,365.46
|
| Rate for Payer: UMR Bronson Commercial |
$2,350.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,006.50
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
OP
|
$5,342.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,181.87 |
| Max. Negotiated Rate |
$6,614.97 |
| Rate for Payer: Aetna American Axle |
$3,472.30
|
| Rate for Payer: Aetna Commercial |
$4,540.70
|
| Rate for Payer: Aetna Medicare |
$2,293.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,472.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,756.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,756.24
|
| Rate for Payer: BCBS Complete |
$1,240.97
|
| Rate for Payer: BCBS MAPPO |
$2,204.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,890.99
|
| Rate for Payer: BCN Commercial |
$2,890.99
|
| Rate for Payer: BCN Medicare Advantage |
$2,204.99
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cofinity Commercial |
$3,739.40
|
| Rate for Payer: Cofinity Commercial |
$4,594.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,739.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,273.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,204.99
|
| Rate for Payer: Healthscope Commercial |
$4,807.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,739.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,006.50
|
| Rate for Payer: Mclaren Medicaid |
$1,181.87
|
| Rate for Payer: Mclaren Medicare |
$2,204.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,315.24
|
| Rate for Payer: Meridian Medicaid |
$1,240.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,535.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,540.70
|
| Rate for Payer: Nomi Health Commercial |
$6,614.97
|
| Rate for Payer: PACE Medicare |
$2,094.74
|
| Rate for Payer: PACE SWMI |
$2,204.99
|
| Rate for Payer: PHP Commercial |
$4,540.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,204.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,181.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,472.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,250.50
|
| Rate for Payer: Priority Health Medicare |
$2,204.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,800.40
|
| Rate for Payer: Priority Health SBD |
$3,365.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,204.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,206.83
|
| Rate for Payer: UHC Core |
$3,590.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,204.99
|
| Rate for Payer: UHC Exchange |
$4,213.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,204.99
|
| Rate for Payer: UHCCP Medicaid |
$1,181.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,976.54
|
| Rate for Payer: VA VA |
$2,204.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,006.50
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
IP
|
$4,863.36
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,139.88 |
| Max. Negotiated Rate |
$4,377.02 |
| Rate for Payer: Aetna American Axle |
$3,161.18
|
| Rate for Payer: Aetna Commercial |
$4,133.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,161.18
|
| Rate for Payer: Cash Price |
$3,890.69
|
| Rate for Payer: Cofinity Commercial |
$3,404.35
|
| Rate for Payer: Cofinity Commercial |
$4,182.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,404.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,890.69
|
| Rate for Payer: Healthscope Commercial |
$4,377.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,404.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,647.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,133.86
|
| Rate for Payer: PHP Commercial |
$4,133.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,161.18
|
| Rate for Payer: Priority Health SBD |
$3,063.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,139.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,647.52
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
OP
|
$4,863.36
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$4,491.63 |
| Rate for Payer: Aetna American Axle |
$3,161.18
|
| Rate for Payer: Aetna Commercial |
$4,133.86
|
| Rate for Payer: Aetna Medicare |
$1,486.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,161.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.82
|
| Rate for Payer: BCN Commercial |
$1,914.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$3,890.69
|
| Rate for Payer: Cash Price |
$3,890.69
|
| Rate for Payer: Cash Price |
$3,890.69
|
| Rate for Payer: Cofinity Commercial |
$3,404.35
|
| Rate for Payer: Cofinity Commercial |
$4,182.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,404.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,890.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$4,377.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,404.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,647.52
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,133.86
|
| Rate for Payer: Nomi Health Commercial |
$4,287.30
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$4,133.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,161.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,491.63
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,593.30
|
| Rate for Payer: Priority Health SBD |
$3,063.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,022.77
|
| Rate for Payer: UHC Core |
$3,590.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,731.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,799.44
|
| Rate for Payer: VA VA |
$1,429.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,647.52
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
OP
|
$4,328.06
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$4,491.63 |
| Rate for Payer: Aetna American Axle |
$2,813.24
|
| Rate for Payer: Aetna Commercial |
$3,678.85
|
| Rate for Payer: Aetna Medicare |
$1,486.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,813.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.82
|
| Rate for Payer: BCN Commercial |
$1,914.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cofinity Commercial |
$3,029.64
|
| Rate for Payer: Cofinity Commercial |
$3,722.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,029.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,462.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$3,895.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,029.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,246.04
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,678.85
|
| Rate for Payer: Nomi Health Commercial |
$4,287.30
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$3,678.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,813.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,491.63
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,593.30
|
| Rate for Payer: Priority Health SBD |
$2,726.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,022.77
|
| Rate for Payer: UHC Core |
$3,590.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,731.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,601.38
|
| Rate for Payer: VA VA |
$1,429.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,246.04
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
IP
|
$4,328.06
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,904.35 |
| Max. Negotiated Rate |
$3,895.25 |
| Rate for Payer: Aetna American Axle |
$2,813.24
|
| Rate for Payer: Aetna Commercial |
$3,678.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,813.24
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cofinity Commercial |
$3,029.64
|
| Rate for Payer: Cofinity Commercial |
$3,722.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,029.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,462.45
|
| Rate for Payer: Healthscope Commercial |
$3,895.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,029.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,246.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,678.85
|
| Rate for Payer: PHP Commercial |
$3,678.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,813.24
|
| Rate for Payer: Priority Health SBD |
$2,726.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,904.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,246.04
|
|
|
HC PET WHOLE BODY
|
Facility
|
OP
|
$5,702.43
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$5,132.19 |
| Rate for Payer: Aetna American Axle |
$3,706.58
|
| Rate for Payer: Aetna Commercial |
$4,847.07
|
| Rate for Payer: Aetna Medicare |
$1,486.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,706.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.82
|
| Rate for Payer: BCN Commercial |
$1,914.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cofinity Commercial |
$3,991.70
|
| Rate for Payer: Cofinity Commercial |
$4,904.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,991.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,561.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$5,132.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,991.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,276.82
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,847.07
|
| Rate for Payer: Nomi Health Commercial |
$4,287.30
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$4,847.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,706.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,491.63
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,593.30
|
| Rate for Payer: Priority Health SBD |
$3,592.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,022.77
|
| Rate for Payer: UHC Core |
$3,590.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,731.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,109.90
|
| Rate for Payer: VA VA |
$1,429.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,276.82
|
|
|
HC PET WHOLE BODY
|
Facility
|
IP
|
$5,702.43
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,509.07 |
| Max. Negotiated Rate |
$5,132.19 |
| Rate for Payer: Aetna American Axle |
$3,706.58
|
| Rate for Payer: Aetna Commercial |
$4,847.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,706.58
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cofinity Commercial |
$3,991.70
|
| Rate for Payer: Cofinity Commercial |
$4,904.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,991.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,561.94
|
| Rate for Payer: Healthscope Commercial |
$5,132.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,991.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,276.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,847.07
|
| Rate for Payer: PHP Commercial |
$4,847.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,706.58
|
| Rate for Payer: Priority Health SBD |
$3,592.53
|
| Rate for Payer: UMR Bronson Commercial |
$2,509.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,276.82
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
IP
|
$7,236.90
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,184.24 |
| Max. Negotiated Rate |
$6,513.21 |
| Rate for Payer: Aetna American Axle |
$4,703.98
|
| Rate for Payer: Aetna Commercial |
$6,151.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,703.98
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cofinity Commercial |
$5,065.83
|
| Rate for Payer: Cofinity Commercial |
$6,223.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,065.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,789.52
|
| Rate for Payer: Healthscope Commercial |
$6,513.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,065.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,427.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,151.36
|
| Rate for Payer: PHP Commercial |
$6,151.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,703.98
|
| Rate for Payer: Priority Health SBD |
$4,559.25
|
| Rate for Payer: UMR Bronson Commercial |
$3,184.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,427.68
|
|
