|
HC MR ABDOMEN WO W CON
|
Facility
|
IP
|
$3,090.30
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,946.89 |
| Max. Negotiated Rate |
$2,781.27 |
| Rate for Payer: Aetna Commercial |
$2,626.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,008.69
|
| Rate for Payer: Cash Price |
$2,472.24
|
| Rate for Payer: Cofinity Commercial |
$2,163.21
|
| Rate for Payer: Cofinity Commercial |
$2,657.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,163.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,472.24
|
| Rate for Payer: Healthscope Commercial |
$2,781.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,626.76
|
| Rate for Payer: PHP Commercial |
$2,626.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,008.69
|
| Rate for Payer: Priority Health SBD |
$1,946.89
|
|
|
HC MRA HEAD WO CON
|
Facility
|
IP
|
$1,809.20
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,139.80 |
| Max. Negotiated Rate |
$1,628.28 |
| Rate for Payer: Aetna Commercial |
$1,537.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.98
|
| Rate for Payer: Cash Price |
$1,447.36
|
| Rate for Payer: Cofinity Commercial |
$1,266.44
|
| Rate for Payer: Cofinity Commercial |
$1,555.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,266.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,447.36
|
| Rate for Payer: Healthscope Commercial |
$1,628.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,537.82
|
| Rate for Payer: PHP Commercial |
$1,537.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.98
|
| Rate for Payer: Priority Health SBD |
$1,139.80
|
|
|
HC MRA HEAD WO CON
|
Facility
|
OP
|
$1,809.20
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,628.28 |
| Rate for Payer: Aetna Commercial |
$1,537.82
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,447.36
|
| Rate for Payer: Cash Price |
$1,447.36
|
| Rate for Payer: Cofinity Commercial |
$1,555.91
|
| Rate for Payer: Cofinity Commercial |
$1,266.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,266.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,447.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,628.28
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,537.82
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$1,537.82
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.98
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$1,139.80
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$1,338.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$1,338.81
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
OP
|
$3,052.80
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,747.52 |
| Rate for Payer: Aetna Commercial |
$2,594.88
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cofinity Commercial |
$2,625.41
|
| Rate for Payer: Cofinity Commercial |
$2,136.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,136.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,747.52
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.88
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$2,594.88
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,984.32
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$1,923.26
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$2,259.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$2,259.07
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
IP
|
$3,052.80
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,923.26 |
| Max. Negotiated Rate |
$2,747.52 |
| Rate for Payer: Aetna Commercial |
$2,594.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.32
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cofinity Commercial |
$2,136.96
|
| Rate for Payer: Cofinity Commercial |
$2,625.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,136.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.24
|
| Rate for Payer: Healthscope Commercial |
$2,747.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.88
|
| Rate for Payer: PHP Commercial |
$2,594.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,984.32
|
| Rate for Payer: Priority Health SBD |
$1,923.26
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
OP
|
$1,412.55
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,271.30 |
| Rate for Payer: Aetna Commercial |
$1,200.67
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,130.04
|
| Rate for Payer: Cash Price |
$1,130.04
|
| Rate for Payer: Cofinity Commercial |
$988.78
|
| Rate for Payer: Cofinity Commercial |
$1,214.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$988.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,271.30
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.67
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$1,200.67
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.16
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$889.91
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$1,045.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$1,045.29
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
IP
|
$1,412.55
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$889.91 |
| Max. Negotiated Rate |
$1,271.30 |
| Rate for Payer: Aetna Commercial |
$1,200.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.16
|
| Rate for Payer: Cash Price |
$1,130.04
|
| Rate for Payer: Cofinity Commercial |
$1,214.79
|
| Rate for Payer: Cofinity Commercial |
$988.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$988.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.04
|
| Rate for Payer: Healthscope Commercial |
$1,271.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.67
|
| Rate for Payer: PHP Commercial |
$1,200.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.16
|
| Rate for Payer: Priority Health SBD |
$889.91
|
|
|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
OP
|
$1,857.93
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$743.17 |
| Max. Negotiated Rate |
$1,672.14 |
| Rate for Payer: Aetna Commercial |
$1,579.24
|
| Rate for Payer: Aetna Medicare |
$928.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.65
|
| Rate for Payer: BCBS Complete |
$743.17
|
| Rate for Payer: Cash Price |
$1,486.34
|
| Rate for Payer: Cofinity Commercial |
$1,300.55
|
| Rate for Payer: Cofinity Commercial |
$1,597.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,300.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.34
|
| Rate for Payer: Healthscope Commercial |
$1,672.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.24
|
| Rate for Payer: PHP Commercial |
$1,579.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,207.65
|
| Rate for Payer: Priority Health SBD |
$1,170.50
|
| Rate for Payer: UHC Core |
$1,374.87
|
| Rate for Payer: UHC Exchange |
$1,374.87
|
|
|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
IP
|
$1,857.93
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,170.50 |
| Max. Negotiated Rate |
$1,672.14 |
| Rate for Payer: Aetna Commercial |
$1,579.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.65
|
| Rate for Payer: Cash Price |
$1,486.34
|
| Rate for Payer: Cofinity Commercial |
$1,300.55
|
| Rate for Payer: Cofinity Commercial |
$1,597.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,300.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.34
|
| Rate for Payer: Healthscope Commercial |
$1,672.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.24
|
| Rate for Payer: PHP Commercial |
$1,579.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,207.65
|
| Rate for Payer: Priority Health SBD |
$1,170.50
|
|
|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
OP
|
$1,548.26
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$619.30 |
| Max. Negotiated Rate |
$1,393.43 |
| Rate for Payer: Aetna Commercial |
$1,316.02
|
| Rate for Payer: Aetna Medicare |
$774.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.37
|
| Rate for Payer: BCBS Complete |
$619.30
|
| Rate for Payer: Cash Price |
$1,238.61
|
| Rate for Payer: Cofinity Commercial |
$1,083.78
|
| Rate for Payer: Cofinity Commercial |
$1,331.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,083.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.61
|
| Rate for Payer: Healthscope Commercial |
$1,393.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,316.02
|
| Rate for Payer: PHP Commercial |
$1,316.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.37
|
| Rate for Payer: Priority Health SBD |
$975.40
|
| Rate for Payer: UHC Core |
$1,145.71
|
| Rate for Payer: UHC Exchange |
$1,145.71
|
|
|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
IP
|
$1,548.26
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$975.40 |
| Max. Negotiated Rate |
$1,393.43 |
| Rate for Payer: Aetna Commercial |
$1,316.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.37
|
| Rate for Payer: Cash Price |
$1,238.61
|
| Rate for Payer: Cofinity Commercial |
$1,083.78
|
| Rate for Payer: Cofinity Commercial |
$1,331.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,083.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.61
|
| Rate for Payer: Healthscope Commercial |
$1,393.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,316.02
|
| Rate for Payer: PHP Commercial |
$1,316.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.37
|
| Rate for Payer: Priority Health SBD |
$975.40
|
|
|
HC MR BRAIN STEREO WO W CON REDUCED
|
Facility
|
OP
|
$2,365.89
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100007
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$946.36 |
| Max. Negotiated Rate |
$2,129.30 |
| Rate for Payer: Aetna Commercial |
$2,011.01
|
| Rate for Payer: Aetna Medicare |
$1,182.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.83
|
| Rate for Payer: BCBS Complete |
$946.36
|
| Rate for Payer: Cash Price |
$1,892.71
|
| Rate for Payer: Cofinity Commercial |
$1,656.12
|
| Rate for Payer: Cofinity Commercial |
$2,034.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,656.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.71
|
| Rate for Payer: Healthscope Commercial |
$2,129.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,011.01
|
| Rate for Payer: PHP Commercial |
$2,011.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.83
|
| Rate for Payer: Priority Health SBD |
$1,490.51
|
| Rate for Payer: UHC Core |
$1,750.76
|
| Rate for Payer: UHC Exchange |
$1,750.76
|
|
|
HC MR BRAIN STEREO WO W CON REDUCED
|
Facility
|
IP
|
$2,365.89
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100007
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,490.51 |
| Max. Negotiated Rate |
$2,129.30 |
| Rate for Payer: Aetna Commercial |
$2,011.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.83
|
| Rate for Payer: Cash Price |
$1,892.71
|
| Rate for Payer: Cofinity Commercial |
$1,656.12
|
| Rate for Payer: Cofinity Commercial |
$2,034.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,656.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.71
|
| Rate for Payer: Healthscope Commercial |
$2,129.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,011.01
|
| Rate for Payer: PHP Commercial |
$2,011.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.83
|
| Rate for Payer: Priority Health SBD |
$1,490.51
|
|
|
HC MR BRAIN W CON
|
Facility
|
OP
|
$2,487.28
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
61100002
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,238.55 |
| Rate for Payer: Aetna Commercial |
$2,114.19
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,616.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,989.82
|
| Rate for Payer: Cash Price |
$1,989.82
|
| Rate for Payer: Cofinity Commercial |
$2,139.06
|
| Rate for Payer: Cofinity Commercial |
$1,741.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,741.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,989.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,238.55
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.19
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$2,114.19
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,616.73
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$1,566.99
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$1,840.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$1,840.59
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR BRAIN W CON
|
Facility
|
IP
|
$2,487.28
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
61100002
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,566.99 |
| Max. Negotiated Rate |
$2,238.55 |
| Rate for Payer: Aetna Commercial |
$2,114.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,616.73
|
| Rate for Payer: Cash Price |
$1,989.82
|
| Rate for Payer: Cofinity Commercial |
$1,741.10
|
| Rate for Payer: Cofinity Commercial |
$2,139.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,741.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,989.82
|
| Rate for Payer: Healthscope Commercial |
$2,238.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.19
|
| Rate for Payer: PHP Commercial |
$2,114.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,616.73
|
| Rate for Payer: Priority Health SBD |
$1,566.99
|
|
|
HC MR BRAIN WO CON
|
Facility
|
IP
|
$2,072.90
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
61100001
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,305.93 |
| Max. Negotiated Rate |
$1,865.61 |
| Rate for Payer: Aetna Commercial |
$1,761.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.38
|
| Rate for Payer: Cash Price |
$1,658.32
|
| Rate for Payer: Cofinity Commercial |
$1,451.03
|
| Rate for Payer: Cofinity Commercial |
$1,782.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,451.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.32
|
| Rate for Payer: Healthscope Commercial |
$1,865.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.96
|
| Rate for Payer: PHP Commercial |
$1,761.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.38
|
| Rate for Payer: Priority Health SBD |
$1,305.93
|
|
|
HC MR BRAIN WO CON
|
Facility
|
OP
|
$2,072.90
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
61100001
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,865.61 |
| Rate for Payer: Aetna Commercial |
$1,761.96
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,658.32
|
| Rate for Payer: Cash Price |
$1,658.32
|
| Rate for Payer: Cofinity Commercial |
$1,451.03
|
| Rate for Payer: Cofinity Commercial |
$1,782.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,451.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,865.61
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.96
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$1,761.96
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.38
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$1,305.93
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$1,533.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$1,533.95
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MR BRAIN WO W CON
|
Facility
|
OP
|
$3,165.73
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
61100003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,849.16 |
| Rate for Payer: Aetna Commercial |
$2,690.87
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,057.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$2,532.58
|
| Rate for Payer: Cash Price |
$2,532.58
|
| Rate for Payer: Cofinity Commercial |
$2,722.53
|
| Rate for Payer: Cofinity Commercial |
$2,216.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,216.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,532.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,849.16
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,690.87
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$2,690.87
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,057.72
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$1,994.41
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$2,342.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$2,342.64
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR BRAIN WO W CON
|
Facility
|
IP
|
$3,165.73
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
61100003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,994.41 |
| Max. Negotiated Rate |
$2,849.16 |
| Rate for Payer: Aetna Commercial |
$2,690.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,057.72
|
| Rate for Payer: Cash Price |
$2,532.58
|
| Rate for Payer: Cofinity Commercial |
$2,216.01
|
| Rate for Payer: Cofinity Commercial |
$2,722.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,216.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,532.58
|
| Rate for Payer: Healthscope Commercial |
$2,849.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,690.87
|
| Rate for Payer: PHP Commercial |
$2,690.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,057.72
|
| Rate for Payer: Priority Health SBD |
$1,994.41
|
|
|
HC MR BREAST ABBREVIATED WO W CON
|
Facility
|
IP
|
$289.45
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$182.35 |
| Max. Negotiated Rate |
$260.50 |
| Rate for Payer: Aetna Commercial |
$246.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.14
|
| Rate for Payer: Cash Price |
$231.56
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Cofinity Commercial |
$248.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.56
|
| Rate for Payer: Healthscope Commercial |
$260.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.03
|
| Rate for Payer: PHP Commercial |
$246.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.14
|
| Rate for Payer: Priority Health SBD |
$182.35
|
|
|
HC MR BREAST ABBREVIATED WO W CON
|
Facility
|
OP
|
$289.45
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$115.78 |
| Max. Negotiated Rate |
$260.50 |
| Rate for Payer: Aetna Commercial |
$246.03
|
| Rate for Payer: Aetna Medicare |
$144.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.14
|
| Rate for Payer: BCBS Complete |
$115.78
|
| Rate for Payer: Cash Price |
$231.56
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Cofinity Commercial |
$248.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.56
|
| Rate for Payer: Healthscope Commercial |
$260.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.03
|
| Rate for Payer: PHP Commercial |
$246.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.14
|
| Rate for Payer: Priority Health SBD |
$182.35
|
| Rate for Payer: UHC Core |
$214.19
|
| Rate for Payer: UHC Exchange |
$214.19
|
|
|
HC MR BREAST BIL SCREEN W CON
|
Facility
|
IP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$777.75 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.44
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Cofinity Commercial |
$864.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$864.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.35
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: Priority Health SBD |
$777.75
|
|
|
HC MR BREAST BIL SCREEN W CON
|
Facility
|
OP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$864.17
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$864.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.35
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$777.75
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$913.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$913.55
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR BREAST BIL SCREEN WO W CON
|
Facility
|
OP
|
$1,259.22
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$1,133.30 |
| Rate for Payer: Aetna Commercial |
$1,070.34
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,007.38
|
| Rate for Payer: Cash Price |
$1,007.38
|
| Rate for Payer: Cofinity Commercial |
$881.45
|
| Rate for Payer: Cofinity Commercial |
$1,082.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$881.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,133.30
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.34
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,070.34
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.49
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$793.31
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$931.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$931.82
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR BREAST BIL SCREEN WO W CON
|
Facility
|
IP
|
$1,259.22
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$793.31 |
| Max. Negotiated Rate |
$1,133.30 |
| Rate for Payer: Aetna Commercial |
$1,070.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.49
|
| Rate for Payer: Cash Price |
$1,007.38
|
| Rate for Payer: Cofinity Commercial |
$1,082.93
|
| Rate for Payer: Cofinity Commercial |
$881.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$881.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.38
|
| Rate for Payer: Healthscope Commercial |
$1,133.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.34
|
| Rate for Payer: PHP Commercial |
$1,070.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.49
|
| Rate for Payer: Priority Health SBD |
$793.31
|
|
