|
HC MPN, CALR GENE MUTATION, EXON 9
|
Facility
|
OP
|
$661.13
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$595.02 |
| Rate for Payer: Aetna Commercial |
$561.96
|
| Rate for Payer: Aetna Medicare |
$171.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$206.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$206.60
|
| Rate for Payer: BCBS Complete |
$122.38
|
| Rate for Payer: BCBS MAPPO |
$165.28
|
| Rate for Payer: BCBS Trust/PPO |
$543.51
|
| Rate for Payer: BCN Commercial |
$543.51
|
| Rate for Payer: BCN Medicare Advantage |
$165.28
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cofinity Commercial |
$568.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.28
|
| Rate for Payer: Healthscope Commercial |
$595.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$495.85
|
| Rate for Payer: Mclaren Medicaid |
$116.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.55
|
| Rate for Payer: Meridian Medicaid |
$122.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$181.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.96
|
| Rate for Payer: Nomi Health Commercial |
$542.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.85
|
| Rate for Payer: PACE Senior Care Partners |
$157.02
|
| Rate for Payer: PACE SWMI |
$165.28
|
| Rate for Payer: PHP Commercial |
$561.96
|
| Rate for Payer: PHP Medicare Advantage |
$165.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$575.18
|
| Rate for Payer: Priority Health Medicare |
$166.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.15
|
| Rate for Payer: Railroad Medicare Medicare |
$165.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.79
|
| Rate for Payer: UHC Core |
$552.04
|
| Rate for Payer: UHC Exchange |
$165.28
|
| Rate for Payer: UHC Medicaid |
$116.56
|
| Rate for Payer: UHC Medicare Advantage |
$165.28
|
| Rate for Payer: UHCCP Medicaid |
$116.56
|
| Rate for Payer: VA VA |
$165.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$495.85
|
|
|
HC MPN, CALR GENE MUTATION, EXON 9
|
Facility
|
IP
|
$661.13
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$460.15 |
| Max. Negotiated Rate |
$595.02 |
| Rate for Payer: Aetna Commercial |
$561.96
|
| Rate for Payer: BCBS Trust/PPO |
$546.03
|
| Rate for Payer: BCN Commercial |
$546.03
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cofinity Commercial |
$568.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.90
|
| Rate for Payer: Healthscope Commercial |
$595.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$495.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.96
|
| Rate for Payer: Nomi Health Commercial |
$542.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.85
|
| Rate for Payer: PHP Commercial |
$561.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$575.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.79
|
| Rate for Payer: UHC Core |
$552.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$495.85
|
|
|
HC MPN (JAK2, V617F, CALR, MPL) REFLEX
|
Facility
|
OP
|
$420.24
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
30000107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.09 |
| Max. Negotiated Rate |
$378.22 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: Aetna Medicare |
$109.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.32
|
| Rate for Payer: BCBS Complete |
$77.79
|
| Rate for Payer: BCBS MAPPO |
$105.06
|
| Rate for Payer: BCBS Trust/PPO |
$345.48
|
| Rate for Payer: BCN Commercial |
$345.48
|
| Rate for Payer: BCN Medicare Advantage |
$105.06
|
| Rate for Payer: Cash Price |
$336.19
|
| Rate for Payer: Cofinity Commercial |
$361.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.06
|
| Rate for Payer: Healthscope Commercial |
$378.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.18
|
| Rate for Payer: Mclaren Medicaid |
$74.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.31
|
| Rate for Payer: Meridian Medicaid |
$77.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.20
|
| Rate for Payer: Nomi Health Commercial |
$344.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.18
|
| Rate for Payer: PACE Senior Care Partners |
$99.81
|
| Rate for Payer: PACE SWMI |
$105.06
|
| Rate for Payer: PHP Commercial |
$357.20
|
| Rate for Payer: PHP Medicare Advantage |
$105.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.61
|
| Rate for Payer: Priority Health Medicare |
$106.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.49
|
| Rate for Payer: Railroad Medicare Medicare |
$105.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.81
|
| Rate for Payer: UHC Core |
$350.90
|
| Rate for Payer: UHC Exchange |
$105.06
|
| Rate for Payer: UHC Medicaid |
$74.09
|
| Rate for Payer: UHC Medicare Advantage |
$105.06
|
| Rate for Payer: UHCCP Medicaid |
$74.09
|
| Rate for Payer: VA VA |
$105.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.18
|
|
|
HC MPN (JAK2, V617F, CALR, MPL) REFLEX
|
Facility
|
IP
|
$420.24
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
30000107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$292.49 |
| Max. Negotiated Rate |
$378.22 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: BCBS Trust/PPO |
$347.08
|
| Rate for Payer: BCN Commercial |
$347.08
|
| Rate for Payer: Cash Price |
$336.19
|
| Rate for Payer: Cofinity Commercial |
$361.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.19
|
| Rate for Payer: Healthscope Commercial |
$378.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.20
|
| Rate for Payer: Nomi Health Commercial |
$344.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.18
|
| Rate for Payer: PHP Commercial |
$357.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.81
|
| Rate for Payer: UHC Core |
$350.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.18
|
|
|
HC MR ABDOMEN W CON
|
Facility
|
OP
|
$2,412.01
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$425.24 |
| Max. Negotiated Rate |
$2,170.81 |
| Rate for Payer: Aetna Commercial |
$2,050.21
|
| Rate for Payer: Aetna Medicare |
$627.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.75
|
| Rate for Payer: BCBS Complete |
$446.46
|
| Rate for Payer: BCBS MAPPO |
$603.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,982.91
|
| Rate for Payer: BCN Commercial |
$1,982.91
|
| Rate for Payer: BCN Medicare Advantage |
$603.00
|
| Rate for Payer: Cash Price |
$1,929.61
|
| Rate for Payer: Cofinity Commercial |
$2,074.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.00
|
| Rate for Payer: Healthscope Commercial |
$2,170.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.01
|
| Rate for Payer: Mclaren Medicaid |
$425.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.15
|
| Rate for Payer: Meridian Medicaid |
$446.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$663.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.21
|
| Rate for Payer: Nomi Health Commercial |
$1,977.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.01
|
| Rate for Payer: PACE Senior Care Partners |
$572.85
|
| Rate for Payer: PACE SWMI |
$603.00
|
| Rate for Payer: PHP Commercial |
$2,050.21
|
| Rate for Payer: PHP Medicare Advantage |
$603.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$425.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,098.45
|
| Rate for Payer: Priority Health Medicare |
$609.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,678.76
|
| Rate for Payer: Railroad Medicare Medicare |
$603.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,122.57
|
| Rate for Payer: UHC Core |
$2,014.03
|
| Rate for Payer: UHC Exchange |
$603.00
|
| Rate for Payer: UHC Medicaid |
$425.24
|
| Rate for Payer: UHC Medicare Advantage |
$603.00
|
| Rate for Payer: UHCCP Medicaid |
$425.24
|
| Rate for Payer: VA VA |
$603.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.01
|
|
|
HC MR ABDOMEN W CON
|
Facility
|
IP
|
$2,412.01
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,678.76 |
| Max. Negotiated Rate |
$2,170.81 |
| Rate for Payer: Aetna Commercial |
$2,050.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,992.08
|
| Rate for Payer: BCN Commercial |
$1,992.08
|
| Rate for Payer: Cash Price |
$1,929.61
|
| Rate for Payer: Cofinity Commercial |
$2,074.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.61
|
| Rate for Payer: Healthscope Commercial |
$2,170.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.21
|
| Rate for Payer: Nomi Health Commercial |
$1,977.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.01
|
| Rate for Payer: PHP Commercial |
$2,050.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,098.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,678.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,122.57
|
| Rate for Payer: UHC Core |
$2,014.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.01
|
|
|
HC MR ABDOMEN WO CON
|
Facility
|
IP
|
$2,152.66
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,498.25 |
| Max. Negotiated Rate |
$1,937.39 |
| Rate for Payer: Aetna Commercial |
$1,829.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,777.88
|
| Rate for Payer: BCN Commercial |
$1,777.88
|
| Rate for Payer: Cash Price |
$1,722.13
|
| Rate for Payer: Cofinity Commercial |
$1,851.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.13
|
| Rate for Payer: Healthscope Commercial |
$1,937.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,614.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.76
|
| Rate for Payer: Nomi Health Commercial |
$1,765.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,614.49
|
| Rate for Payer: PHP Commercial |
$1,829.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,872.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,498.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,894.34
|
| Rate for Payer: UHC Core |
$1,797.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,614.49
|
|
|
HC MR ABDOMEN WO CON
|
Facility
|
OP
|
$2,152.66
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$379.51 |
| Max. Negotiated Rate |
$1,937.39 |
| Rate for Payer: Aetna Commercial |
$1,829.76
|
| Rate for Payer: Aetna Medicare |
$559.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$672.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$672.71
|
| Rate for Payer: BCBS Complete |
$398.46
|
| Rate for Payer: BCBS MAPPO |
$538.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,769.70
|
| Rate for Payer: BCN Commercial |
$1,769.70
|
| Rate for Payer: BCN Medicare Advantage |
$538.16
|
| Rate for Payer: Cash Price |
$1,722.13
|
| Rate for Payer: Cofinity Commercial |
$1,851.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.16
|
| Rate for Payer: Healthscope Commercial |
$1,937.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,614.49
|
| Rate for Payer: Mclaren Medicaid |
$379.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$565.07
|
| Rate for Payer: Meridian Medicaid |
$398.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.76
|
| Rate for Payer: Nomi Health Commercial |
$1,765.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,614.49
|
| Rate for Payer: PACE Senior Care Partners |
$511.26
|
| Rate for Payer: PACE SWMI |
$538.16
|
| Rate for Payer: PHP Commercial |
$1,829.76
|
| Rate for Payer: PHP Medicare Advantage |
$538.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$379.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,872.81
|
| Rate for Payer: Priority Health Medicare |
$543.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,498.25
|
| Rate for Payer: Railroad Medicare Medicare |
$538.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,894.34
|
| Rate for Payer: UHC Core |
$1,797.47
|
| Rate for Payer: UHC Exchange |
$538.16
|
| Rate for Payer: UHC Medicaid |
$379.51
|
| Rate for Payer: UHC Medicare Advantage |
$538.16
|
| Rate for Payer: UHCCP Medicaid |
$379.51
|
| Rate for Payer: VA VA |
$538.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,614.49
|
|
|
HC MR ABDOMEN WO W CON
|
Facility
|
OP
|
$3,152.11
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$555.72 |
| Max. Negotiated Rate |
$2,836.90 |
| Rate for Payer: Aetna Commercial |
$2,679.29
|
| Rate for Payer: Aetna Medicare |
$819.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$985.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$985.03
|
| Rate for Payer: BCBS Complete |
$583.46
|
| Rate for Payer: BCBS MAPPO |
$788.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,591.35
|
| Rate for Payer: BCN Commercial |
$2,591.35
|
| Rate for Payer: BCN Medicare Advantage |
$788.03
|
| Rate for Payer: Cash Price |
$2,521.69
|
| Rate for Payer: Cofinity Commercial |
$2,710.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,521.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$788.03
|
| Rate for Payer: Healthscope Commercial |
$2,836.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,364.08
|
| Rate for Payer: Mclaren Medicaid |
$555.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$827.43
|
| Rate for Payer: Meridian Medicaid |
$583.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$906.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$866.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,679.29
|
| Rate for Payer: Nomi Health Commercial |
$2,584.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,364.08
|
| Rate for Payer: PACE Senior Care Partners |
$748.63
|
| Rate for Payer: PACE SWMI |
$788.03
|
| Rate for Payer: PHP Commercial |
$2,679.29
|
| Rate for Payer: PHP Medicare Advantage |
$788.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$555.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,742.34
|
| Rate for Payer: Priority Health Medicare |
$795.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,193.87
|
| Rate for Payer: Railroad Medicare Medicare |
$788.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,773.86
|
| Rate for Payer: UHC Core |
$2,632.01
|
| Rate for Payer: UHC Exchange |
$788.03
|
| Rate for Payer: UHC Medicaid |
$555.72
|
| Rate for Payer: UHC Medicare Advantage |
$788.03
|
| Rate for Payer: UHCCP Medicaid |
$555.72
|
| Rate for Payer: VA VA |
$788.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,364.08
|
|
|
HC MR ABDOMEN WO W CON
|
Facility
|
IP
|
$3,152.11
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,193.87 |
| Max. Negotiated Rate |
$2,836.90 |
| Rate for Payer: Aetna Commercial |
$2,679.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,603.33
|
| Rate for Payer: BCN Commercial |
$2,603.33
|
| Rate for Payer: Cash Price |
$2,521.69
|
| Rate for Payer: Cofinity Commercial |
$2,710.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,521.69
|
| Rate for Payer: Healthscope Commercial |
$2,836.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,364.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,679.29
|
| Rate for Payer: Nomi Health Commercial |
$2,584.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,364.08
|
| Rate for Payer: PHP Commercial |
$2,679.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,742.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,193.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,773.86
|
| Rate for Payer: UHC Core |
$2,632.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,364.08
|
|
|
HC MRA HEAD WO CON
|
Facility
|
IP
|
$1,845.38
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,284.38 |
| Max. Negotiated Rate |
$1,660.84 |
| Rate for Payer: Aetna Commercial |
$1,568.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,524.10
|
| Rate for Payer: BCN Commercial |
$1,524.10
|
| Rate for Payer: Cash Price |
$1,476.30
|
| Rate for Payer: Cofinity Commercial |
$1,587.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,476.30
|
| Rate for Payer: Healthscope Commercial |
$1,660.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,384.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,568.57
|
| Rate for Payer: Nomi Health Commercial |
$1,513.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,384.04
|
| Rate for Payer: PHP Commercial |
$1,568.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,605.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,284.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,623.93
|
| Rate for Payer: UHC Core |
$1,540.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,384.04
|
|
|
HC MRA HEAD WO CON
|
Facility
|
OP
|
$1,845.38
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$325.34 |
| Max. Negotiated Rate |
$1,660.84 |
| Rate for Payer: Aetna Commercial |
$1,568.57
|
| Rate for Payer: Aetna Medicare |
$479.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$576.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$576.68
|
| Rate for Payer: BCBS Complete |
$341.58
|
| Rate for Payer: BCBS MAPPO |
$461.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.09
|
| Rate for Payer: BCN Commercial |
$1,517.09
|
| Rate for Payer: BCN Medicare Advantage |
$461.35
|
| Rate for Payer: Cash Price |
$1,476.30
|
| Rate for Payer: Cofinity Commercial |
$1,587.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,476.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$461.35
|
| Rate for Payer: Healthscope Commercial |
$1,660.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,384.04
|
| Rate for Payer: Mclaren Medicaid |
$325.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$484.41
|
| Rate for Payer: Meridian Medicaid |
$341.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$530.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$507.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,568.57
|
| Rate for Payer: Nomi Health Commercial |
$1,513.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,384.04
|
| Rate for Payer: PACE Senior Care Partners |
$438.28
|
| Rate for Payer: PACE SWMI |
$461.35
|
| Rate for Payer: PHP Commercial |
$1,568.57
|
| Rate for Payer: PHP Medicare Advantage |
$461.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,605.48
|
| Rate for Payer: Priority Health Medicare |
$465.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,284.38
|
| Rate for Payer: Railroad Medicare Medicare |
$461.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,623.93
|
| Rate for Payer: UHC Core |
$1,540.89
|
| Rate for Payer: UHC Exchange |
$461.35
|
| Rate for Payer: UHC Medicaid |
$325.34
|
| Rate for Payer: UHC Medicare Advantage |
$461.35
|
| Rate for Payer: UHCCP Medicaid |
$325.34
|
| Rate for Payer: VA VA |
$461.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,384.04
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
IP
|
$3,113.86
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,167.25 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,646.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,571.74
|
| Rate for Payer: BCN Commercial |
$2,571.74
|
| Rate for Payer: Cash Price |
$2,491.09
|
| Rate for Payer: Cofinity Commercial |
$2,677.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,491.09
|
| Rate for Payer: Healthscope Commercial |
$2,802.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,335.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,646.78
|
| Rate for Payer: Nomi Health Commercial |
$2,553.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,335.39
|
| Rate for Payer: PHP Commercial |
$2,646.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,709.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,167.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,740.20
|
| Rate for Payer: UHC Core |
$2,600.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,335.39
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
OP
|
$3,113.86
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$548.97 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,646.78
|
| Rate for Payer: Aetna Medicare |
$809.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$973.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$973.08
|
| Rate for Payer: BCBS Complete |
$576.38
|
| Rate for Payer: BCBS MAPPO |
$778.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,559.90
|
| Rate for Payer: BCN Commercial |
$2,559.90
|
| Rate for Payer: BCN Medicare Advantage |
$778.47
|
| Rate for Payer: Cash Price |
$2,491.09
|
| Rate for Payer: Cofinity Commercial |
$2,677.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,491.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$778.47
|
| Rate for Payer: Healthscope Commercial |
$2,802.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,335.39
|
| Rate for Payer: Mclaren Medicaid |
$548.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$817.39
|
| Rate for Payer: Meridian Medicaid |
$576.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$895.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$856.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,646.78
|
| Rate for Payer: Nomi Health Commercial |
$2,553.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,335.39
|
| Rate for Payer: PACE Senior Care Partners |
$739.54
|
| Rate for Payer: PACE SWMI |
$778.47
|
| Rate for Payer: PHP Commercial |
$2,646.78
|
| Rate for Payer: PHP Medicare Advantage |
$778.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$548.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,709.06
|
| Rate for Payer: Priority Health Medicare |
$786.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,167.25
|
| Rate for Payer: Railroad Medicare Medicare |
$778.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,740.20
|
| Rate for Payer: UHC Core |
$2,600.07
|
| Rate for Payer: UHC Exchange |
$778.47
|
| Rate for Payer: UHC Medicaid |
$548.97
|
| Rate for Payer: UHC Medicare Advantage |
$778.47
|
| Rate for Payer: UHCCP Medicaid |
$548.97
|
| Rate for Payer: VA VA |
$778.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,335.39
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
OP
|
$1,440.80
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$254.01 |
| Max. Negotiated Rate |
$1,296.72 |
| Rate for Payer: Aetna Commercial |
$1,224.68
|
| Rate for Payer: Aetna Medicare |
$374.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$450.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$450.25
|
| Rate for Payer: BCBS Complete |
$266.69
|
| Rate for Payer: BCBS MAPPO |
$360.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,184.48
|
| Rate for Payer: BCN Commercial |
$1,184.48
|
| Rate for Payer: BCN Medicare Advantage |
$360.20
|
| Rate for Payer: Cash Price |
$1,152.64
|
| Rate for Payer: Cofinity Commercial |
$1,239.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$360.20
|
| Rate for Payer: Healthscope Commercial |
$1,296.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,080.60
|
| Rate for Payer: Mclaren Medicaid |
$254.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$378.21
|
| Rate for Payer: Meridian Medicaid |
$266.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$414.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$396.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,224.68
|
| Rate for Payer: Nomi Health Commercial |
$1,181.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.60
|
| Rate for Payer: PACE Senior Care Partners |
$342.19
|
| Rate for Payer: PACE SWMI |
$360.20
|
| Rate for Payer: PHP Commercial |
$1,224.68
|
| Rate for Payer: PHP Medicare Advantage |
$360.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,253.50
|
| Rate for Payer: Priority Health Medicare |
$363.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,002.80
|
| Rate for Payer: Railroad Medicare Medicare |
$360.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,267.90
|
| Rate for Payer: UHC Core |
$1,203.07
|
| Rate for Payer: UHC Exchange |
$360.20
|
| Rate for Payer: UHC Medicaid |
$254.01
|
| Rate for Payer: UHC Medicare Advantage |
$360.20
|
| Rate for Payer: UHCCP Medicaid |
$254.01
|
| Rate for Payer: VA VA |
$360.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,080.60
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
IP
|
$1,440.80
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,002.80 |
| Max. Negotiated Rate |
$1,296.72 |
| Rate for Payer: Aetna Commercial |
$1,224.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,189.96
|
| Rate for Payer: BCN Commercial |
$1,189.96
|
| Rate for Payer: Cash Price |
$1,152.64
|
| Rate for Payer: Cofinity Commercial |
$1,239.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.64
|
| Rate for Payer: Healthscope Commercial |
$1,296.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,080.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,224.68
|
| Rate for Payer: Nomi Health Commercial |
$1,181.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.60
|
| Rate for Payer: PHP Commercial |
$1,224.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,253.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,002.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,267.90
|
| Rate for Payer: UHC Core |
$1,203.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,080.60
|
|
|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
IP
|
$1,895.09
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,318.98 |
| Max. Negotiated Rate |
$1,705.58 |
| Rate for Payer: Aetna Commercial |
$1,610.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,565.15
|
| Rate for Payer: BCN Commercial |
$1,565.15
|
| Rate for Payer: Cash Price |
$1,516.07
|
| Rate for Payer: Cofinity Commercial |
$1,629.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,516.07
|
| Rate for Payer: Healthscope Commercial |
$1,705.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,421.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,610.83
|
| Rate for Payer: Nomi Health Commercial |
$1,553.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,421.32
|
| Rate for Payer: PHP Commercial |
$1,610.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,648.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,318.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,667.68
|
| Rate for Payer: UHC Core |
$1,582.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,421.32
|
|
|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
OP
|
$1,895.09
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$334.10 |
| Max. Negotiated Rate |
$1,705.58 |
| Rate for Payer: Aetna Commercial |
$1,610.83
|
| Rate for Payer: Aetna Medicare |
$492.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$592.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$592.22
|
| Rate for Payer: BCBS Complete |
$350.78
|
| Rate for Payer: BCBS MAPPO |
$473.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,557.95
|
| Rate for Payer: BCN Commercial |
$1,557.95
|
| Rate for Payer: BCN Medicare Advantage |
$473.77
|
| Rate for Payer: Cash Price |
$1,516.07
|
| Rate for Payer: Cofinity Commercial |
$1,629.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,516.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$473.77
|
| Rate for Payer: Healthscope Commercial |
$1,705.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,421.32
|
| Rate for Payer: Mclaren Medicaid |
$334.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$497.46
|
| Rate for Payer: Meridian Medicaid |
$350.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$544.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$521.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,610.83
|
| Rate for Payer: Nomi Health Commercial |
$1,553.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,421.32
|
| Rate for Payer: PACE Senior Care Partners |
$450.08
|
| Rate for Payer: PACE SWMI |
$473.77
|
| Rate for Payer: PHP Commercial |
$1,610.83
|
| Rate for Payer: PHP Medicare Advantage |
$473.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$334.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,648.73
|
| Rate for Payer: Priority Health Medicare |
$478.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,318.98
|
| Rate for Payer: Railroad Medicare Medicare |
$473.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,667.68
|
| Rate for Payer: UHC Core |
$1,582.40
|
| Rate for Payer: UHC Exchange |
$473.77
|
| Rate for Payer: UHC Medicaid |
$334.10
|
| Rate for Payer: UHC Medicare Advantage |
$473.77
|
| Rate for Payer: UHCCP Medicaid |
$334.10
|
| Rate for Payer: VA VA |
$473.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,421.32
|
|
|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
OP
|
$1,579.23
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$278.42 |
| Max. Negotiated Rate |
$1,421.31 |
| Rate for Payer: Aetna Commercial |
$1,342.35
|
| Rate for Payer: Aetna Medicare |
$410.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$493.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$493.51
|
| Rate for Payer: BCBS Complete |
$292.32
|
| Rate for Payer: BCBS MAPPO |
$394.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,298.28
|
| Rate for Payer: BCN Commercial |
$1,298.28
|
| Rate for Payer: BCN Medicare Advantage |
$394.81
|
| Rate for Payer: Cash Price |
$1,263.38
|
| Rate for Payer: Cofinity Commercial |
$1,358.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.81
|
| Rate for Payer: Healthscope Commercial |
$1,421.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,184.42
|
| Rate for Payer: Mclaren Medicaid |
$278.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.55
|
| Rate for Payer: Meridian Medicaid |
$292.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$454.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$434.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,342.35
|
| Rate for Payer: Nomi Health Commercial |
$1,294.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,184.42
|
| Rate for Payer: PACE Senior Care Partners |
$375.07
|
| Rate for Payer: PACE SWMI |
$394.81
|
| Rate for Payer: PHP Commercial |
$1,342.35
|
| Rate for Payer: PHP Medicare Advantage |
$394.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,373.93
|
| Rate for Payer: Priority Health Medicare |
$398.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,099.14
|
| Rate for Payer: Railroad Medicare Medicare |
$394.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,389.72
|
| Rate for Payer: UHC Core |
$1,318.66
|
| Rate for Payer: UHC Exchange |
$394.81
|
| Rate for Payer: UHC Medicaid |
$278.42
|
| Rate for Payer: UHC Medicare Advantage |
$394.81
|
| Rate for Payer: UHCCP Medicaid |
$278.42
|
| Rate for Payer: VA VA |
$394.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,184.42
|
|
|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
IP
|
$1,579.23
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,099.14 |
| Max. Negotiated Rate |
$1,421.31 |
| Rate for Payer: Aetna Commercial |
$1,342.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.29
|
| Rate for Payer: BCN Commercial |
$1,304.29
|
| Rate for Payer: Cash Price |
$1,263.38
|
| Rate for Payer: Cofinity Commercial |
$1,358.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.38
|
| Rate for Payer: Healthscope Commercial |
$1,421.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,184.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,342.35
|
| Rate for Payer: Nomi Health Commercial |
$1,294.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,184.42
|
| Rate for Payer: PHP Commercial |
$1,342.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,373.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,099.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,389.72
|
| Rate for Payer: UHC Core |
$1,318.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,184.42
|
|
|
HC MR BRAIN STEREO WO W CON REDUCED
|
Facility
|
IP
|
$2,413.21
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100007
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,679.59 |
| Max. Negotiated Rate |
$2,171.89 |
| Rate for Payer: Aetna Commercial |
$2,051.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,993.07
|
| Rate for Payer: BCN Commercial |
$1,993.07
|
| Rate for Payer: Cash Price |
$1,930.57
|
| Rate for Payer: Cofinity Commercial |
$2,075.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,930.57
|
| Rate for Payer: Healthscope Commercial |
$2,171.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,051.23
|
| Rate for Payer: Nomi Health Commercial |
$1,978.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.91
|
| Rate for Payer: PHP Commercial |
$2,051.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,099.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,679.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,123.62
|
| Rate for Payer: UHC Core |
$2,015.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.91
|
|
|
HC MR BRAIN STEREO WO W CON REDUCED
|
Facility
|
OP
|
$2,413.21
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100007
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$425.45 |
| Max. Negotiated Rate |
$2,171.89 |
| Rate for Payer: Aetna Commercial |
$2,051.23
|
| Rate for Payer: Aetna Medicare |
$627.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$754.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$754.13
|
| Rate for Payer: BCBS Complete |
$446.69
|
| Rate for Payer: BCBS MAPPO |
$603.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,983.90
|
| Rate for Payer: BCN Commercial |
$1,983.90
|
| Rate for Payer: BCN Medicare Advantage |
$603.30
|
| Rate for Payer: Cash Price |
$1,930.57
|
| Rate for Payer: Cofinity Commercial |
$2,075.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,930.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.30
|
| Rate for Payer: Healthscope Commercial |
$2,171.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.91
|
| Rate for Payer: Mclaren Medicaid |
$425.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.47
|
| Rate for Payer: Meridian Medicaid |
$446.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$663.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,051.23
|
| Rate for Payer: Nomi Health Commercial |
$1,978.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.91
|
| Rate for Payer: PACE Senior Care Partners |
$573.14
|
| Rate for Payer: PACE SWMI |
$603.30
|
| Rate for Payer: PHP Commercial |
$2,051.23
|
| Rate for Payer: PHP Medicare Advantage |
$603.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$425.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,099.49
|
| Rate for Payer: Priority Health Medicare |
$609.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,679.59
|
| Rate for Payer: Railroad Medicare Medicare |
$603.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,123.62
|
| Rate for Payer: UHC Core |
$2,015.03
|
| Rate for Payer: UHC Exchange |
$603.30
|
| Rate for Payer: UHC Medicaid |
$425.45
|
| Rate for Payer: UHC Medicare Advantage |
$603.30
|
| Rate for Payer: UHCCP Medicaid |
$425.45
|
| Rate for Payer: VA VA |
$603.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.91
|
|
|
HC MR BRAIN W CON
|
Facility
|
IP
|
$2,537.03
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
61100002
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,765.77 |
| Max. Negotiated Rate |
$2,283.33 |
| Rate for Payer: Aetna Commercial |
$2,156.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,095.33
|
| Rate for Payer: BCN Commercial |
$2,095.33
|
| Rate for Payer: Cash Price |
$2,029.62
|
| Rate for Payer: Cofinity Commercial |
$2,181.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,029.62
|
| Rate for Payer: Healthscope Commercial |
$2,283.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,902.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,156.48
|
| Rate for Payer: Nomi Health Commercial |
$2,080.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,902.77
|
| Rate for Payer: PHP Commercial |
$2,156.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,207.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,765.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,232.59
|
| Rate for Payer: UHC Core |
$2,118.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,902.77
|
|
|
HC MR BRAIN W CON
|
Facility
|
OP
|
$2,537.03
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
61100002
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$447.28 |
| Max. Negotiated Rate |
$2,283.33 |
| Rate for Payer: Aetna Commercial |
$2,156.48
|
| Rate for Payer: Aetna Medicare |
$659.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$792.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$792.82
|
| Rate for Payer: BCBS Complete |
$469.60
|
| Rate for Payer: BCBS MAPPO |
$634.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,085.69
|
| Rate for Payer: BCN Commercial |
$2,085.69
|
| Rate for Payer: BCN Medicare Advantage |
$634.26
|
| Rate for Payer: Cash Price |
$2,029.62
|
| Rate for Payer: Cofinity Commercial |
$2,181.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,029.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$634.26
|
| Rate for Payer: Healthscope Commercial |
$2,283.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,902.77
|
| Rate for Payer: Mclaren Medicaid |
$447.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$665.97
|
| Rate for Payer: Meridian Medicaid |
$469.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$729.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$697.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,156.48
|
| Rate for Payer: Nomi Health Commercial |
$2,080.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,902.77
|
| Rate for Payer: PACE Senior Care Partners |
$602.54
|
| Rate for Payer: PACE SWMI |
$634.26
|
| Rate for Payer: PHP Commercial |
$2,156.48
|
| Rate for Payer: PHP Medicare Advantage |
$634.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,207.22
|
| Rate for Payer: Priority Health Medicare |
$640.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,765.77
|
| Rate for Payer: Railroad Medicare Medicare |
$634.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,232.59
|
| Rate for Payer: UHC Core |
$2,118.42
|
| Rate for Payer: UHC Exchange |
$634.26
|
| Rate for Payer: UHC Medicaid |
$447.28
|
| Rate for Payer: UHC Medicare Advantage |
$634.26
|
| Rate for Payer: UHCCP Medicaid |
$447.28
|
| Rate for Payer: VA VA |
$634.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,902.77
|
|
|
HC MR BRAIN WO CON
|
Facility
|
OP
|
$2,114.36
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
61100001
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$372.76 |
| Max. Negotiated Rate |
$1,902.92 |
| Rate for Payer: Aetna Commercial |
$1,797.21
|
| Rate for Payer: Aetna Medicare |
$549.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$660.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$660.74
|
| Rate for Payer: BCBS Complete |
$391.37
|
| Rate for Payer: BCBS MAPPO |
$528.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,738.22
|
| Rate for Payer: BCN Commercial |
$1,738.22
|
| Rate for Payer: BCN Medicare Advantage |
$528.59
|
| Rate for Payer: Cash Price |
$1,691.49
|
| Rate for Payer: Cofinity Commercial |
$1,818.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.59
|
| Rate for Payer: Healthscope Commercial |
$1,902.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,585.77
|
| Rate for Payer: Mclaren Medicaid |
$372.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.02
|
| Rate for Payer: Meridian Medicaid |
$391.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$607.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$581.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,797.21
|
| Rate for Payer: Nomi Health Commercial |
$1,733.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,585.77
|
| Rate for Payer: PACE Senior Care Partners |
$502.16
|
| Rate for Payer: PACE SWMI |
$528.59
|
| Rate for Payer: PHP Commercial |
$1,797.21
|
| Rate for Payer: PHP Medicare Advantage |
$528.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,839.49
|
| Rate for Payer: Priority Health Medicare |
$533.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,471.59
|
| Rate for Payer: Railroad Medicare Medicare |
$528.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,860.64
|
| Rate for Payer: UHC Core |
$1,765.49
|
| Rate for Payer: UHC Exchange |
$528.59
|
| Rate for Payer: UHC Medicaid |
$372.76
|
| Rate for Payer: UHC Medicare Advantage |
$528.59
|
| Rate for Payer: UHCCP Medicaid |
$372.76
|
| Rate for Payer: VA VA |
$528.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.77
|
|
