|
HC MR MRA UPPER EXTREMITY WO C
|
Facility
|
IP
|
$1,756.74
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
61000078
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,071.44 |
| Max. Negotiated Rate |
$1,581.07 |
| Rate for Payer: Aetna Commercial |
$1,493.23
|
| Rate for Payer: Aetna Commercial |
$2,239.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,036.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,357.61
|
| Rate for Payer: BCN Commercial |
$1,357.61
|
| Rate for Payer: BCN Commercial |
$2,036.41
|
| Rate for Payer: Cash Price |
$2,108.09
|
| Rate for Payer: Cash Price |
$1,405.39
|
| Rate for Payer: Cofinity Commercial |
$1,510.80
|
| Rate for Payer: Cofinity Commercial |
$2,266.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.09
|
| Rate for Payer: Healthscope Commercial |
$2,371.60
|
| Rate for Payer: Healthscope Commercial |
$1,581.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,976.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,493.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,239.84
|
| Rate for Payer: PHP Commercial |
$2,239.84
|
| Rate for Payer: PHP Commercial |
$1,493.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,292.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,528.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,071.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,607.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,318.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,545.93
|
| Rate for Payer: UHC Core |
$1,466.88
|
| Rate for Payer: UHC Core |
$2,200.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,976.33
|
|
|
HC MR MRA UPPER EXTREMITY WO C
|
Facility
|
OP
|
$2,635.11
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
61000078
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$2,371.60 |
| Rate for Payer: Aetna Commercial |
$2,239.84
|
| Rate for Payer: Aetna Commercial |
$1,493.23
|
| Rate for Payer: Aetna Medicare |
$685.13
|
| Rate for Payer: Aetna Medicare |
$456.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$548.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$548.98
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$658.78
|
| Rate for Payer: BCBS MAPPO |
$439.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,365.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,048.80
|
| Rate for Payer: BCN Commercial |
$1,365.87
|
| Rate for Payer: BCN Commercial |
$2,048.80
|
| Rate for Payer: BCN Medicare Advantage |
$439.18
|
| Rate for Payer: BCN Medicare Advantage |
$658.78
|
| Rate for Payer: Cash Price |
$2,108.09
|
| Rate for Payer: Cash Price |
$1,405.39
|
| Rate for Payer: Cash Price |
$2,108.09
|
| Rate for Payer: Cash Price |
$1,405.39
|
| Rate for Payer: Cofinity Commercial |
$1,510.80
|
| Rate for Payer: Cofinity Commercial |
$2,266.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.78
|
| Rate for Payer: Healthscope Commercial |
$1,581.07
|
| Rate for Payer: Healthscope Commercial |
$2,371.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,976.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.56
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$691.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$461.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,239.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,493.23
|
| Rate for Payer: PACE Senior Care Partners |
$417.23
|
| Rate for Payer: PACE Senior Care Partners |
$625.84
|
| Rate for Payer: PACE SWMI |
$439.18
|
| Rate for Payer: PACE SWMI |
$658.78
|
| Rate for Payer: PHP Commercial |
$1,493.23
|
| Rate for Payer: PHP Commercial |
$2,239.84
|
| Rate for Payer: PHP Medicare Advantage |
$658.78
|
| Rate for Payer: PHP Medicare Advantage |
$439.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,292.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,528.36
|
| Rate for Payer: Priority Health Medicare |
$439.18
|
| Rate for Payer: Priority Health Medicare |
$658.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,607.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,071.44
|
| Rate for Payer: Railroad Medicare Medicare |
$658.78
|
| Rate for Payer: Railroad Medicare Medicare |
$439.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,545.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,318.90
|
| Rate for Payer: UHC Core |
$2,200.32
|
| Rate for Payer: UHC Core |
$1,466.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.78
|
| Rate for Payer: UHC Medicare Advantage |
$678.54
|
| Rate for Payer: UHC Medicare Advantage |
$452.36
|
| Rate for Payer: VA VA |
$439.18
|
| Rate for Payer: VA VA |
$658.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,976.33
|
|
|
HC MR MRA UPPER EXTREMITY WO W
|
Facility
|
IP
|
$3,074.07
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
61000079
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,874.88 |
| Max. Negotiated Rate |
$2,766.66 |
| Rate for Payer: Aetna Commercial |
$2,612.96
|
| Rate for Payer: Aetna Commercial |
$1,741.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,375.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,583.76
|
| Rate for Payer: BCN Commercial |
$2,375.64
|
| Rate for Payer: BCN Commercial |
$1,583.76
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cofinity Commercial |
$1,762.47
|
| Rate for Payer: Cofinity Commercial |
$2,643.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,459.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,639.50
|
| Rate for Payer: Healthscope Commercial |
$1,844.44
|
| Rate for Payer: Healthscope Commercial |
$2,766.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,305.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,537.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,741.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,612.96
|
| Rate for Payer: PHP Commercial |
$2,612.96
|
| Rate for Payer: PHP Commercial |
$1,741.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,434.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,782.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,674.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,874.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,249.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,803.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,705.18
|
| Rate for Payer: UHC Core |
$1,711.23
|
| Rate for Payer: UHC Core |
$2,566.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,537.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,305.55
|
|
|
HC MR MRA UPPER EXTREMITY WO W
|
Facility
|
OP
|
$2,049.38
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
61000079
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$1,844.44 |
| Rate for Payer: Aetna Commercial |
$1,741.97
|
| Rate for Payer: Aetna Commercial |
$2,612.96
|
| Rate for Payer: Aetna Medicare |
$532.84
|
| Rate for Payer: Aetna Medicare |
$799.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$960.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$640.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$640.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$960.65
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$768.52
|
| Rate for Payer: BCBS MAPPO |
$512.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,390.09
|
| Rate for Payer: BCN Commercial |
$2,390.09
|
| Rate for Payer: BCN Commercial |
$1,593.39
|
| Rate for Payer: BCN Medicare Advantage |
$512.34
|
| Rate for Payer: BCN Medicare Advantage |
$768.52
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cofinity Commercial |
$2,643.70
|
| Rate for Payer: Cofinity Commercial |
$1,762.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,459.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,639.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$768.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.34
|
| Rate for Payer: Healthscope Commercial |
$1,844.44
|
| Rate for Payer: Healthscope Commercial |
$2,766.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,305.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,537.04
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$806.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$537.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$883.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$589.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,741.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,612.96
|
| Rate for Payer: PACE Senior Care Partners |
$730.09
|
| Rate for Payer: PACE Senior Care Partners |
$486.73
|
| Rate for Payer: PACE SWMI |
$768.52
|
| Rate for Payer: PACE SWMI |
$512.34
|
| Rate for Payer: PHP Commercial |
$2,612.96
|
| Rate for Payer: PHP Commercial |
$1,741.97
|
| Rate for Payer: PHP Medicare Advantage |
$768.52
|
| Rate for Payer: PHP Medicare Advantage |
$512.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,434.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,674.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,782.96
|
| Rate for Payer: Priority Health Medicare |
$768.52
|
| Rate for Payer: Priority Health Medicare |
$512.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,874.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,249.92
|
| Rate for Payer: Railroad Medicare Medicare |
$768.52
|
| Rate for Payer: Railroad Medicare Medicare |
$512.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,803.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,705.18
|
| Rate for Payer: UHC Core |
$1,711.23
|
| Rate for Payer: UHC Core |
$2,566.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$512.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$768.52
|
| Rate for Payer: UHC Medicare Advantage |
$791.57
|
| Rate for Payer: UHC Medicare Advantage |
$527.72
|
| Rate for Payer: VA VA |
$768.52
|
| Rate for Payer: VA VA |
$512.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,305.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,537.04
|
|
|
HC MR MRCP
|
Facility
|
IP
|
$2,069.07
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,261.93 |
| Max. Negotiated Rate |
$1,862.16 |
| Rate for Payer: Aetna Commercial |
$1,758.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,598.98
|
| Rate for Payer: BCN Commercial |
$1,598.98
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cofinity Commercial |
$1,779.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,655.26
|
| Rate for Payer: Healthscope Commercial |
$1,862.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,551.80
|
| 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 HMO/PPO/Tiered Network |
$1,800.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,261.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,820.78
|
| Rate for Payer: UHC Core |
$1,727.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,551.80
|
|
|
HC MR MRCP
|
Facility
|
OP
|
$2,069.07
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$1,862.16 |
| Rate for Payer: Aetna Commercial |
$1,758.71
|
| Rate for Payer: Aetna Medicare |
$537.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.58
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$517.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,608.70
|
| Rate for Payer: BCN Commercial |
$1,608.70
|
| Rate for Payer: BCN Medicare Advantage |
$517.27
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cofinity Commercial |
$1,779.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,655.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.27
|
| Rate for Payer: Healthscope Commercial |
$1,862.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,551.80
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$543.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$594.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,758.71
|
| Rate for Payer: PACE Senior Care Partners |
$491.40
|
| Rate for Payer: PACE SWMI |
$517.27
|
| Rate for Payer: PHP Commercial |
$1,758.71
|
| Rate for Payer: PHP Medicare Advantage |
$517.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,800.09
|
| Rate for Payer: Priority Health Medicare |
$517.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,261.93
|
| Rate for Payer: Railroad Medicare Medicare |
$517.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,820.78
|
| Rate for Payer: UHC Core |
$1,727.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.27
|
| Rate for Payer: UHC Medicare Advantage |
$532.79
|
| Rate for Payer: VA VA |
$517.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,551.80
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
OP
|
$985.70
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$234.10 |
| Max. Negotiated Rate |
$887.13 |
| Rate for Payer: Aetna Commercial |
$837.84
|
| Rate for Payer: Aetna Medicare |
$256.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$308.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$308.03
|
| Rate for Payer: BCBS Complete |
$394.28
|
| Rate for Payer: BCBS MAPPO |
$246.42
|
| Rate for Payer: BCBS Trust/PPO |
$766.38
|
| Rate for Payer: BCN Commercial |
$766.38
|
| Rate for Payer: BCN Medicare Advantage |
$246.42
|
| Rate for Payer: Cash Price |
$788.56
|
| Rate for Payer: Cofinity Commercial |
$847.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.42
|
| Rate for Payer: Healthscope Commercial |
$887.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$739.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$258.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$837.84
|
| Rate for Payer: PACE Senior Care Partners |
$234.10
|
| Rate for Payer: PACE SWMI |
$246.42
|
| Rate for Payer: PHP Commercial |
$837.84
|
| Rate for Payer: PHP Medicare Advantage |
$246.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$857.56
|
| Rate for Payer: Priority Health Medicare |
$246.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$601.18
|
| Rate for Payer: Railroad Medicare Medicare |
$246.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$867.42
|
| Rate for Payer: UHC Core |
$823.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.42
|
| Rate for Payer: UHC Medicare Advantage |
$253.82
|
| Rate for Payer: VA VA |
$246.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$739.28
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
IP
|
$985.70
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$601.18 |
| Max. Negotiated Rate |
$887.13 |
| Rate for Payer: Aetna Commercial |
$837.84
|
| Rate for Payer: BCBS Trust/PPO |
$761.75
|
| Rate for Payer: BCN Commercial |
$761.75
|
| Rate for Payer: Cash Price |
$788.56
|
| Rate for Payer: Cofinity Commercial |
$847.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.56
|
| Rate for Payer: Healthscope Commercial |
$887.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$739.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$837.84
|
| Rate for Payer: PHP Commercial |
$837.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$857.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$601.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$867.42
|
| Rate for Payer: UHC Core |
$823.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$739.28
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
OP
|
$2,173.50
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$1,956.15 |
| Rate for Payer: Aetna Commercial |
$1,847.48
|
| Rate for Payer: Aetna Medicare |
$565.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$679.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$679.22
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$543.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,689.90
|
| Rate for Payer: BCN Commercial |
$1,689.90
|
| Rate for Payer: BCN Medicare Advantage |
$543.38
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cofinity Commercial |
$1,869.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,738.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.38
|
| Rate for Payer: Healthscope Commercial |
$1,956.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,630.12
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$570.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$624.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,847.48
|
| Rate for Payer: PACE Senior Care Partners |
$516.21
|
| Rate for Payer: PACE SWMI |
$543.38
|
| Rate for Payer: PHP Commercial |
$1,847.48
|
| Rate for Payer: PHP Medicare Advantage |
$543.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,521.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,890.94
|
| Rate for Payer: Priority Health Medicare |
$543.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,325.62
|
| Rate for Payer: Railroad Medicare Medicare |
$543.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,912.68
|
| Rate for Payer: UHC Core |
$1,814.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$543.38
|
| Rate for Payer: UHC Medicare Advantage |
$559.68
|
| Rate for Payer: VA VA |
$543.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,630.12
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
IP
|
$2,173.50
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,325.62 |
| Max. Negotiated Rate |
$1,956.15 |
| Rate for Payer: Aetna Commercial |
$1,847.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,679.68
|
| Rate for Payer: BCN Commercial |
$1,679.68
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cofinity Commercial |
$1,869.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,738.80
|
| Rate for Payer: Healthscope Commercial |
$1,956.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,630.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,847.48
|
| Rate for Payer: PHP Commercial |
$1,847.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,521.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,890.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,325.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,912.68
|
| Rate for Payer: UHC Core |
$1,814.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,630.12
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
IP
|
$2,104.40
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,283.47 |
| Max. Negotiated Rate |
$1,893.96 |
| Rate for Payer: Aetna Commercial |
$1,788.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,626.28
|
| Rate for Payer: BCN Commercial |
$1,626.28
|
| Rate for Payer: Cash Price |
$1,683.52
|
| Rate for Payer: Cofinity Commercial |
$1,809.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,683.52
|
| Rate for Payer: Healthscope Commercial |
$1,893.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,578.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,788.74
|
| Rate for Payer: PHP Commercial |
$1,788.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,830.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,283.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,851.87
|
| Rate for Payer: UHC Core |
$1,757.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,578.30
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
OP
|
$2,104.40
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$1,893.96 |
| Rate for Payer: Aetna Commercial |
$1,788.74
|
| Rate for Payer: Aetna Medicare |
$547.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$657.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$657.62
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$526.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.17
|
| Rate for Payer: BCN Commercial |
$1,636.17
|
| Rate for Payer: BCN Medicare Advantage |
$526.10
|
| Rate for Payer: Cash Price |
$1,683.52
|
| Rate for Payer: Cash Price |
$1,683.52
|
| Rate for Payer: Cofinity Commercial |
$1,809.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,683.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$526.10
|
| Rate for Payer: Healthscope Commercial |
$1,893.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,578.30
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$552.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$605.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,788.74
|
| Rate for Payer: PACE Senior Care Partners |
$499.80
|
| Rate for Payer: PACE SWMI |
$526.10
|
| Rate for Payer: PHP Commercial |
$1,788.74
|
| Rate for Payer: PHP Medicare Advantage |
$526.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,830.83
|
| Rate for Payer: Priority Health Medicare |
$526.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,283.47
|
| Rate for Payer: Railroad Medicare Medicare |
$526.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,851.87
|
| Rate for Payer: UHC Core |
$1,757.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$526.10
|
| Rate for Payer: UHC Medicare Advantage |
$541.88
|
| Rate for Payer: VA VA |
$526.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,578.30
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
IP
|
$1,995.22
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,216.88 |
| Max. Negotiated Rate |
$1,795.70 |
| Rate for Payer: Aetna Commercial |
$1,695.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,541.91
|
| Rate for Payer: BCN Commercial |
$1,541.91
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cofinity Commercial |
$1,715.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.18
|
| Rate for Payer: Healthscope Commercial |
$1,795.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,496.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,695.94
|
| Rate for Payer: PHP Commercial |
$1,695.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,735.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,216.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,755.79
|
| Rate for Payer: UHC Core |
$1,666.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,496.42
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
OP
|
$1,995.22
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$1,795.70 |
| Rate for Payer: Aetna Commercial |
$1,695.94
|
| Rate for Payer: Aetna Medicare |
$518.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.51
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$498.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.28
|
| Rate for Payer: BCN Commercial |
$1,551.28
|
| Rate for Payer: BCN Medicare Advantage |
$498.80
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cofinity Commercial |
$1,715.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.80
|
| Rate for Payer: Healthscope Commercial |
$1,795.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,496.42
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$523.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,695.94
|
| Rate for Payer: PACE Senior Care Partners |
$473.86
|
| Rate for Payer: PACE SWMI |
$498.80
|
| Rate for Payer: PHP Commercial |
$1,695.94
|
| Rate for Payer: PHP Medicare Advantage |
$498.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,735.84
|
| Rate for Payer: Priority Health Medicare |
$498.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,216.88
|
| Rate for Payer: Railroad Medicare Medicare |
$498.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,755.79
|
| Rate for Payer: UHC Core |
$1,666.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.80
|
| Rate for Payer: UHC Medicare Advantage |
$513.77
|
| Rate for Payer: VA VA |
$498.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,496.42
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
OP
|
$2,734.06
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$2,460.65 |
| Rate for Payer: Aetna Commercial |
$2,323.95
|
| Rate for Payer: Aetna Medicare |
$710.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$854.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$854.39
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$683.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,125.73
|
| Rate for Payer: BCN Commercial |
$2,125.73
|
| Rate for Payer: BCN Medicare Advantage |
$683.52
|
| Rate for Payer: Cash Price |
$2,187.25
|
| Rate for Payer: Cash Price |
$2,187.25
|
| Rate for Payer: Cofinity Commercial |
$2,351.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,187.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.52
|
| Rate for Payer: Healthscope Commercial |
$2,460.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,050.54
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$717.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$786.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,323.95
|
| Rate for Payer: PACE Senior Care Partners |
$649.34
|
| Rate for Payer: PACE SWMI |
$683.52
|
| Rate for Payer: PHP Commercial |
$2,323.95
|
| Rate for Payer: PHP Medicare Advantage |
$683.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,913.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,378.63
|
| Rate for Payer: Priority Health Medicare |
$683.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,667.50
|
| Rate for Payer: Railroad Medicare Medicare |
$683.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,405.97
|
| Rate for Payer: UHC Core |
$2,282.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.52
|
| Rate for Payer: UHC Medicare Advantage |
$704.02
|
| Rate for Payer: VA VA |
$683.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,050.54
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
IP
|
$2,734.06
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,667.50 |
| Max. Negotiated Rate |
$2,460.65 |
| Rate for Payer: Aetna Commercial |
$2,323.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,112.88
|
| Rate for Payer: BCN Commercial |
$2,112.88
|
| Rate for Payer: Cash Price |
$2,187.25
|
| Rate for Payer: Cofinity Commercial |
$2,351.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,187.25
|
| Rate for Payer: Healthscope Commercial |
$2,460.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,050.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,323.95
|
| Rate for Payer: PHP Commercial |
$2,323.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,913.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,378.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,667.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,405.97
|
| Rate for Payer: UHC Core |
$2,282.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,050.54
|
|
|
HC MR PELVIS W CON
|
Facility
|
IP
|
$2,199.20
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,341.29 |
| Max. Negotiated Rate |
$1,979.28 |
| Rate for Payer: Aetna Commercial |
$1,869.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,699.54
|
| Rate for Payer: BCN Commercial |
$1,699.54
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cofinity Commercial |
$1,891.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,759.36
|
| Rate for Payer: Healthscope Commercial |
$1,979.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,649.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,869.32
|
| Rate for Payer: PHP Commercial |
$1,869.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,539.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,913.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,341.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,935.30
|
| Rate for Payer: UHC Core |
$1,836.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,649.40
|
|
|
HC MR PELVIS W CON
|
Facility
|
OP
|
$2,199.20
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$1,979.28 |
| Rate for Payer: Aetna Commercial |
$1,869.32
|
| Rate for Payer: Aetna Medicare |
$571.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$687.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$687.25
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$549.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.88
|
| Rate for Payer: BCN Commercial |
$1,709.88
|
| Rate for Payer: BCN Medicare Advantage |
$549.80
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cofinity Commercial |
$1,891.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,759.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$549.80
|
| Rate for Payer: Healthscope Commercial |
$1,979.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,649.40
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$577.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$632.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,869.32
|
| Rate for Payer: PACE Senior Care Partners |
$522.31
|
| Rate for Payer: PACE SWMI |
$549.80
|
| Rate for Payer: PHP Commercial |
$1,869.32
|
| Rate for Payer: PHP Medicare Advantage |
$549.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,539.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,913.30
|
| Rate for Payer: Priority Health Medicare |
$549.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,341.29
|
| Rate for Payer: Railroad Medicare Medicare |
$549.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,935.30
|
| Rate for Payer: UHC Core |
$1,836.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$549.80
|
| Rate for Payer: UHC Medicare Advantage |
$566.29
|
| Rate for Payer: VA VA |
$549.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,649.40
|
|
|
HC MR PELVIS WO CON
|
Facility
|
IP
|
$1,992.88
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,215.46 |
| Max. Negotiated Rate |
$1,793.59 |
| Rate for Payer: Aetna Commercial |
$1,693.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.10
|
| Rate for Payer: BCN Commercial |
$1,540.10
|
| Rate for Payer: Cash Price |
$1,594.30
|
| Rate for Payer: Cofinity Commercial |
$1,713.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,594.30
|
| Rate for Payer: Healthscope Commercial |
$1,793.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,494.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.95
|
| Rate for Payer: PHP Commercial |
$1,693.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,733.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,215.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,753.73
|
| Rate for Payer: UHC Core |
$1,664.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,494.66
|
|
|
HC MR PELVIS WO CON
|
Facility
|
OP
|
$1,992.88
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$1,793.59 |
| Rate for Payer: Aetna Commercial |
$1,693.95
|
| Rate for Payer: Aetna Medicare |
$518.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$622.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$622.78
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$498.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,549.46
|
| Rate for Payer: BCN Commercial |
$1,549.46
|
| Rate for Payer: BCN Medicare Advantage |
$498.22
|
| Rate for Payer: Cash Price |
$1,594.30
|
| Rate for Payer: Cash Price |
$1,594.30
|
| Rate for Payer: Cofinity Commercial |
$1,713.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,594.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.22
|
| Rate for Payer: Healthscope Commercial |
$1,793.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,494.66
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$523.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$572.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.95
|
| Rate for Payer: PACE Senior Care Partners |
$473.31
|
| Rate for Payer: PACE SWMI |
$498.22
|
| Rate for Payer: PHP Commercial |
$1,693.95
|
| Rate for Payer: PHP Medicare Advantage |
$498.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,733.81
|
| Rate for Payer: Priority Health Medicare |
$498.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,215.46
|
| Rate for Payer: Railroad Medicare Medicare |
$498.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,753.73
|
| Rate for Payer: UHC Core |
$1,664.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.22
|
| Rate for Payer: UHC Medicare Advantage |
$513.17
|
| Rate for Payer: VA VA |
$498.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,494.66
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
IP
|
$2,989.37
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,823.22 |
| Max. Negotiated Rate |
$2,690.43 |
| Rate for Payer: Aetna Commercial |
$2,540.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,310.19
|
| Rate for Payer: BCN Commercial |
$2,310.19
|
| Rate for Payer: Cash Price |
$2,391.50
|
| Rate for Payer: Cofinity Commercial |
$2,570.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.50
|
| Rate for Payer: Healthscope Commercial |
$2,690.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,242.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,540.96
|
| Rate for Payer: PHP Commercial |
$2,540.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,600.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,823.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,630.65
|
| Rate for Payer: UHC Core |
$2,496.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,242.03
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
OP
|
$2,989.37
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$2,690.43 |
| Rate for Payer: Aetna Commercial |
$2,540.96
|
| Rate for Payer: Aetna Medicare |
$777.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$934.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$934.18
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$747.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,324.24
|
| Rate for Payer: BCN Commercial |
$2,324.24
|
| Rate for Payer: BCN Medicare Advantage |
$747.34
|
| Rate for Payer: Cash Price |
$2,391.50
|
| Rate for Payer: Cash Price |
$2,391.50
|
| Rate for Payer: Cofinity Commercial |
$2,570.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.34
|
| Rate for Payer: Healthscope Commercial |
$2,690.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,242.03
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$784.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$859.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,540.96
|
| Rate for Payer: PACE Senior Care Partners |
$709.98
|
| Rate for Payer: PACE SWMI |
$747.34
|
| Rate for Payer: PHP Commercial |
$2,540.96
|
| Rate for Payer: PHP Medicare Advantage |
$747.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,600.75
|
| Rate for Payer: Priority Health Medicare |
$747.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,823.22
|
| Rate for Payer: Railroad Medicare Medicare |
$747.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,630.65
|
| Rate for Payer: UHC Core |
$2,496.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.34
|
| Rate for Payer: UHC Medicare Advantage |
$769.76
|
| Rate for Payer: VA VA |
$747.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,242.03
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
IP
|
$1,862.90
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,136.18 |
| Max. Negotiated Rate |
$1,676.61 |
| Rate for Payer: Aetna Commercial |
$1,583.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,439.65
|
| Rate for Payer: BCN Commercial |
$1,439.65
|
| Rate for Payer: Cash Price |
$1,490.32
|
| Rate for Payer: Cofinity Commercial |
$1,602.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,490.32
|
| Rate for Payer: Healthscope Commercial |
$1,676.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,397.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,583.46
|
| Rate for Payer: PHP Commercial |
$1,583.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,304.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,620.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,136.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,639.35
|
| Rate for Payer: UHC Core |
$1,555.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,397.18
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
OP
|
$1,862.90
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$1,676.61 |
| Rate for Payer: Aetna Commercial |
$1,583.46
|
| Rate for Payer: Aetna Medicare |
$484.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$582.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$582.16
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$465.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,448.40
|
| Rate for Payer: BCN Commercial |
$1,448.40
|
| Rate for Payer: BCN Medicare Advantage |
$465.72
|
| Rate for Payer: Cash Price |
$1,490.32
|
| Rate for Payer: Cash Price |
$1,490.32
|
| Rate for Payer: Cofinity Commercial |
$1,602.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,490.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.72
|
| Rate for Payer: Healthscope Commercial |
$1,676.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,397.18
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$489.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$535.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,583.46
|
| Rate for Payer: PACE Senior Care Partners |
$442.44
|
| Rate for Payer: PACE SWMI |
$465.72
|
| Rate for Payer: PHP Commercial |
$1,583.46
|
| Rate for Payer: PHP Medicare Advantage |
$465.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,304.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,620.72
|
| Rate for Payer: Priority Health Medicare |
$465.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,136.18
|
| Rate for Payer: Railroad Medicare Medicare |
$465.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,639.35
|
| Rate for Payer: UHC Core |
$1,555.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.72
|
| Rate for Payer: UHC Medicare Advantage |
$479.70
|
| Rate for Payer: VA VA |
$465.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,397.18
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
IP
|
$2,276.80
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,388.62 |
| Max. Negotiated Rate |
$2,049.12 |
| Rate for Payer: Aetna Commercial |
$1,935.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,759.51
|
| Rate for Payer: BCN Commercial |
$1,759.51
|
| Rate for Payer: Cash Price |
$1,821.44
|
| Rate for Payer: Cofinity Commercial |
$1,958.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.44
|
| Rate for Payer: Healthscope Commercial |
$2,049.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,707.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,935.28
|
| Rate for Payer: PHP Commercial |
$1,935.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,593.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,980.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,388.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,003.58
|
| Rate for Payer: UHC Core |
$1,901.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,707.60
|
|
