|
HC MR ABDOMEN W CON
|
Facility
|
IP
|
$2,318.35
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,460.56 |
| Max. Negotiated Rate |
$2,086.52 |
| Rate for Payer: Aetna Commercial |
$1,970.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,506.93
|
| Rate for Payer: Cash Price |
$1,854.68
|
| Rate for Payer: Cofinity Commercial |
$1,622.84
|
| Rate for Payer: Cofinity Commercial |
$1,993.78
|
| Rate for Payer: Healthscope Commercial |
$2,086.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,970.60
|
| Rate for Payer: PHP Commercial |
$1,970.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,622.84
|
| Rate for Payer: Priority Health SBD |
$1,460.56
|
|
|
HC MR ABDOMEN W CON
|
Facility
|
OP
|
$2,318.35
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$2,086.52 |
| Rate for Payer: Aetna Commercial |
$1,970.60
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,506.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$388.88
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$1,854.68
|
| Rate for Payer: Cash Price |
$1,854.68
|
| Rate for Payer: Cofinity Commercial |
$1,993.78
|
| Rate for Payer: Cofinity Commercial |
$1,622.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$2,086.52
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,970.60
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$1,970.60
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,622.84
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$1,460.56
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$305.50
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC MR ABDOMEN WO CON
|
Facility
|
IP
|
$2,069.07
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,303.51 |
| Max. Negotiated Rate |
$1,862.16 |
| Rate for Payer: Aetna Commercial |
$1,758.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.90
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cofinity Commercial |
$1,448.35
|
| Rate for Payer: Cofinity Commercial |
$1,779.40
|
| Rate for Payer: Healthscope Commercial |
$1,862.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,758.71
|
| Rate for Payer: PHP Commercial |
$1,758.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.35
|
| Rate for Payer: Priority Health SBD |
$1,303.51
|
|
|
HC MR ABDOMEN WO CON
|
Facility
|
OP
|
$2,069.07
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,862.16 |
| Rate for Payer: Aetna Commercial |
$1,758.71
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$223.95
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cofinity Commercial |
$1,448.35
|
| Rate for Payer: Cofinity Commercial |
$1,779.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,862.16
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,758.71
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,758.71
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.35
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health SBD |
$1,303.51
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$197.77
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC MR ABDOMEN WO W CON
|
Facility
|
IP
|
$3,029.71
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,908.72 |
| Max. Negotiated Rate |
$2,726.74 |
| Rate for Payer: Aetna Commercial |
$2,575.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,969.31
|
| Rate for Payer: Cash Price |
$2,423.77
|
| Rate for Payer: Cofinity Commercial |
$2,120.80
|
| Rate for Payer: Cofinity Commercial |
$2,605.55
|
| Rate for Payer: Healthscope Commercial |
$2,726.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,575.25
|
| Rate for Payer: PHP Commercial |
$2,575.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,120.80
|
| Rate for Payer: Priority Health SBD |
$1,908.72
|
|
|
HC MR ABDOMEN WO W CON
|
Facility
|
OP
|
$3,029.71
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$2,726.74 |
| Rate for Payer: Aetna Commercial |
$2,575.25
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,969.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$414.25
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$2,423.77
|
| Rate for Payer: Cash Price |
$2,423.77
|
| Rate for Payer: Cofinity Commercial |
$2,605.55
|
| Rate for Payer: Cofinity Commercial |
$2,120.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$2,726.74
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,575.25
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$2,575.25
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,120.80
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$1,908.72
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$341.52
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC MRA HEAD WO CON
|
Facility
|
IP
|
$1,773.73
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,117.45 |
| Max. Negotiated Rate |
$1,596.36 |
| Rate for Payer: Aetna Commercial |
$1,507.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,152.92
|
| Rate for Payer: Cash Price |
$1,418.98
|
| Rate for Payer: Cofinity Commercial |
$1,241.61
|
| Rate for Payer: Cofinity Commercial |
$1,525.41
|
| Rate for Payer: Healthscope Commercial |
$1,596.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,507.67
|
| Rate for Payer: PHP Commercial |
$1,507.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,241.61
|
| Rate for Payer: Priority Health SBD |
$1,117.45
|
|
|
HC MRA HEAD WO CON
|
Facility
|
OP
|
$1,773.73
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,596.36 |
| Rate for Payer: Aetna Commercial |
$1,507.67
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,152.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$276.91
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,418.98
|
| Rate for Payer: Cash Price |
$1,418.98
|
| Rate for Payer: Cofinity Commercial |
$1,241.61
|
| Rate for Payer: Cofinity Commercial |
$1,525.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,596.36
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,507.67
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,507.67
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,241.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.43
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health Narrow Network |
$573.14
|
| Rate for Payer: Priority Health SBD |
$1,117.45
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$217.75
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
IP
|
$2,992.94
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,885.55 |
| Max. Negotiated Rate |
$2,693.65 |
| Rate for Payer: Aetna Commercial |
$2,544.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.41
|
| Rate for Payer: Cash Price |
$2,394.35
|
| Rate for Payer: Cofinity Commercial |
$2,573.93
|
| Rate for Payer: Cofinity Commercial |
$2,095.06
|
| Rate for Payer: Healthscope Commercial |
$2,693.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,544.00
|
| Rate for Payer: PHP Commercial |
$2,544.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.06
|
| Rate for Payer: Priority Health SBD |
$1,885.55
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
OP
|
$2,992.94
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$2,693.65 |
| Rate for Payer: Aetna Commercial |
$2,544.00
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$452.31
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$2,394.35
|
| Rate for Payer: Cash Price |
$2,394.35
|
| Rate for Payer: Cofinity Commercial |
$2,573.93
|
| Rate for Payer: Cofinity Commercial |
$2,095.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$2,693.65
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,544.00
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$2,544.00
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,146.57
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health Narrow Network |
$917.26
|
| Rate for Payer: Priority Health SBD |
$1,885.55
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$333.34
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
IP
|
$1,384.85
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$872.46 |
| Max. Negotiated Rate |
$1,246.36 |
| Rate for Payer: Aetna Commercial |
$1,177.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.15
|
| Rate for Payer: Cash Price |
$1,107.88
|
| Rate for Payer: Cofinity Commercial |
$1,190.97
|
| Rate for Payer: Cofinity Commercial |
$969.40
|
| Rate for Payer: Healthscope Commercial |
$1,246.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,177.12
|
| Rate for Payer: PHP Commercial |
$1,177.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.40
|
| Rate for Payer: Priority Health SBD |
$872.46
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
OP
|
$1,384.85
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,246.36 |
| Rate for Payer: Aetna Commercial |
$1,177.12
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$424.73
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,107.88
|
| Rate for Payer: Cash Price |
$1,107.88
|
| Rate for Payer: Cofinity Commercial |
$969.40
|
| Rate for Payer: Cofinity Commercial |
$1,190.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,246.36
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,177.12
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,177.12
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.43
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health Narrow Network |
$573.14
|
| Rate for Payer: Priority Health SBD |
$872.46
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$320.24
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
OP
|
$1,821.50
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$417.82 |
| Max. Negotiated Rate |
$1,639.35 |
| Rate for Payer: Aetna Commercial |
$1,548.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,183.98
|
| Rate for Payer: BCBS Complete |
$728.60
|
| Rate for Payer: BCBS Trust/PPO |
$594.07
|
| Rate for Payer: Cash Price |
$1,457.20
|
| Rate for Payer: Cash Price |
$1,457.20
|
| Rate for Payer: Cofinity Commercial |
$1,566.49
|
| Rate for Payer: Cofinity Commercial |
$1,275.05
|
| Rate for Payer: Healthscope Commercial |
$1,639.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,548.28
|
| Rate for Payer: PHP Commercial |
$1,548.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.05
|
| Rate for Payer: Priority Health SBD |
$1,147.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.60
|
| Rate for Payer: UHC Exchange |
$417.82
|
|
|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
IP
|
$1,821.50
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,147.54 |
| Max. Negotiated Rate |
$1,639.35 |
| Rate for Payer: Aetna Commercial |
$1,548.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,183.98
|
| Rate for Payer: Cash Price |
$1,457.20
|
| Rate for Payer: Cofinity Commercial |
$1,275.05
|
| Rate for Payer: Cofinity Commercial |
$1,566.49
|
| Rate for Payer: Healthscope Commercial |
$1,639.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,548.28
|
| Rate for Payer: PHP Commercial |
$1,548.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.05
|
| Rate for Payer: Priority Health SBD |
$1,147.54
|
|
|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
IP
|
$1,517.90
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$956.28 |
| Max. Negotiated Rate |
$1,366.11 |
| Rate for Payer: Aetna Commercial |
$1,290.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.64
|
| Rate for Payer: Cash Price |
$1,214.32
|
| Rate for Payer: Cofinity Commercial |
$1,062.53
|
| Rate for Payer: Cofinity Commercial |
$1,305.39
|
| Rate for Payer: Healthscope Commercial |
$1,366.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,290.22
|
| Rate for Payer: PHP Commercial |
$1,290.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,062.53
|
| Rate for Payer: Priority Health SBD |
$956.28
|
|
|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
OP
|
$1,517.90
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$417.82 |
| Max. Negotiated Rate |
$1,366.11 |
| Rate for Payer: Aetna Commercial |
$1,290.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.64
|
| Rate for Payer: BCBS Complete |
$607.16
|
| Rate for Payer: BCBS Trust/PPO |
$594.07
|
| Rate for Payer: Cash Price |
$1,214.32
|
| Rate for Payer: Cash Price |
$1,214.32
|
| Rate for Payer: Cofinity Commercial |
$1,305.39
|
| Rate for Payer: Cofinity Commercial |
$1,062.53
|
| Rate for Payer: Healthscope Commercial |
$1,366.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,290.22
|
| Rate for Payer: PHP Commercial |
$1,290.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,062.53
|
| Rate for Payer: Priority Health SBD |
$956.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.60
|
| Rate for Payer: UHC Exchange |
$417.82
|
|
|
HC MR BRAIN STEREO WO W CON REDUCED
|
Facility
|
IP
|
$2,319.50
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100007
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,461.28 |
| Max. Negotiated Rate |
$2,087.55 |
| Rate for Payer: Aetna Commercial |
$1,971.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,507.68
|
| Rate for Payer: Cash Price |
$1,855.60
|
| Rate for Payer: Cofinity Commercial |
$1,994.77
|
| Rate for Payer: Cofinity Commercial |
$1,623.65
|
| Rate for Payer: Healthscope Commercial |
$2,087.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,971.58
|
| Rate for Payer: PHP Commercial |
$1,971.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,623.65
|
| Rate for Payer: Priority Health SBD |
$1,461.28
|
|
|
HC MR BRAIN STEREO WO W CON REDUCED
|
Facility
|
OP
|
$2,319.50
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100007
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$417.82 |
| Max. Negotiated Rate |
$2,087.55 |
| Rate for Payer: Aetna Commercial |
$1,971.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,507.68
|
| Rate for Payer: BCBS Complete |
$927.80
|
| Rate for Payer: BCBS Trust/PPO |
$594.07
|
| Rate for Payer: Cash Price |
$1,855.60
|
| Rate for Payer: Cash Price |
$1,855.60
|
| Rate for Payer: Cofinity Commercial |
$1,994.77
|
| Rate for Payer: Cofinity Commercial |
$1,623.65
|
| Rate for Payer: Healthscope Commercial |
$2,087.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,971.58
|
| Rate for Payer: PHP Commercial |
$1,971.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,623.65
|
| Rate for Payer: Priority Health SBD |
$1,461.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.60
|
| Rate for Payer: UHC Exchange |
$417.82
|
|
|
HC MR BRAIN W CON
|
Facility
|
OP
|
$2,438.51
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
61100002
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$2,194.66 |
| Rate for Payer: Aetna Commercial |
$2,072.73
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,585.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$327.10
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$1,950.81
|
| Rate for Payer: Cash Price |
$1,950.81
|
| Rate for Payer: Cofinity Commercial |
$2,097.12
|
| Rate for Payer: Cofinity Commercial |
$1,706.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$2,194.66
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,072.73
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$2,072.73
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,706.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,146.57
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health Narrow Network |
$917.26
|
| Rate for Payer: Priority Health SBD |
$1,536.26
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$273.09
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC MR BRAIN W CON
|
Facility
|
IP
|
$2,438.51
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
61100002
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,536.26 |
| Max. Negotiated Rate |
$2,194.66 |
| Rate for Payer: Aetna Commercial |
$2,072.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,585.03
|
| Rate for Payer: Cash Price |
$1,950.81
|
| Rate for Payer: Cofinity Commercial |
$1,706.96
|
| Rate for Payer: Cofinity Commercial |
$2,097.12
|
| Rate for Payer: Healthscope Commercial |
$2,194.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,072.73
|
| Rate for Payer: PHP Commercial |
$2,072.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,706.96
|
| Rate for Payer: Priority Health SBD |
$1,536.26
|
|
|
HC MR BRAIN WO CON
|
Facility
|
OP
|
$2,032.25
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
61100001
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,829.02 |
| Rate for Payer: Aetna Commercial |
$1,727.41
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$221.19
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cofinity Commercial |
$1,747.74
|
| Rate for Payer: Cofinity Commercial |
$1,422.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,829.02
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,727.41
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,727.41
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,422.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.43
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health Narrow Network |
$573.14
|
| Rate for Payer: Priority Health SBD |
$1,280.32
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$198.10
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC MR BRAIN WO CON
|
Facility
|
IP
|
$2,032.25
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
61100001
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,280.32 |
| Max. Negotiated Rate |
$1,829.02 |
| Rate for Payer: Aetna Commercial |
$1,727.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.96
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cofinity Commercial |
$1,422.58
|
| Rate for Payer: Cofinity Commercial |
$1,747.74
|
| Rate for Payer: Healthscope Commercial |
$1,829.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,727.41
|
| Rate for Payer: PHP Commercial |
$1,727.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,422.58
|
| Rate for Payer: Priority Health SBD |
$1,280.32
|
|
|
HC MR BRAIN WO W CON
|
Facility
|
OP
|
$3,103.66
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
61100003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$2,793.29 |
| Rate for Payer: Aetna Commercial |
$2,638.11
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,017.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$370.68
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$2,482.93
|
| Rate for Payer: Cash Price |
$2,482.93
|
| Rate for Payer: Cofinity Commercial |
$2,669.15
|
| Rate for Payer: Cofinity Commercial |
$2,172.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$2,793.29
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,638.11
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$2,638.11
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,146.57
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health Narrow Network |
$917.26
|
| Rate for Payer: Priority Health SBD |
$1,955.31
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$321.55
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC MR BRAIN WO W CON
|
Facility
|
IP
|
$3,103.66
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
61100003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,955.31 |
| Max. Negotiated Rate |
$2,793.29 |
| Rate for Payer: Aetna Commercial |
$2,638.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,017.38
|
| Rate for Payer: Cash Price |
$2,482.93
|
| Rate for Payer: Cofinity Commercial |
$2,172.56
|
| Rate for Payer: Cofinity Commercial |
$2,669.15
|
| Rate for Payer: Healthscope Commercial |
$2,793.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,638.11
|
| Rate for Payer: PHP Commercial |
$2,638.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.56
|
| Rate for Payer: Priority Health SBD |
$1,955.31
|
|
|
HC MR BREAST ABBREVIATED WO W CON
|
Facility
|
IP
|
$283.77
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$178.78 |
| Max. Negotiated Rate |
$255.39 |
| Rate for Payer: Aetna Commercial |
$241.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.45
|
| Rate for Payer: Cash Price |
$227.02
|
| Rate for Payer: Cofinity Commercial |
$198.64
|
| Rate for Payer: Cofinity Commercial |
$244.04
|
| Rate for Payer: Healthscope Commercial |
$255.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.20
|
| Rate for Payer: PHP Commercial |
$241.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.64
|
| Rate for Payer: Priority Health SBD |
$178.78
|
|
