|
HC MR ORBITS FACE NECK W CON
|
Facility
|
IP
|
$2,189.42
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,523.84 |
| Max. Negotiated Rate |
$1,970.48 |
| Rate for Payer: Aetna Commercial |
$1,861.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.24
|
| Rate for Payer: BCN Commercial |
$1,808.24
|
| Rate for Payer: Cash Price |
$1,751.54
|
| Rate for Payer: Cofinity Commercial |
$1,882.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.54
|
| Rate for Payer: Healthscope Commercial |
$1,970.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,642.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.01
|
| Rate for Payer: Nomi Health Commercial |
$1,795.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,642.07
|
| Rate for Payer: PHP Commercial |
$1,861.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,904.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,523.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,926.69
|
| Rate for Payer: UHC Core |
$1,828.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,642.07
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
OP
|
$2,189.42
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$385.99 |
| Max. Negotiated Rate |
$1,970.48 |
| Rate for Payer: Aetna Commercial |
$1,861.01
|
| Rate for Payer: Aetna Medicare |
$569.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$684.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$684.19
|
| Rate for Payer: BCBS Complete |
$405.26
|
| Rate for Payer: BCBS MAPPO |
$547.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.92
|
| Rate for Payer: BCN Commercial |
$1,799.92
|
| Rate for Payer: BCN Medicare Advantage |
$547.36
|
| Rate for Payer: Cash Price |
$1,751.54
|
| Rate for Payer: Cofinity Commercial |
$1,882.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.36
|
| Rate for Payer: Healthscope Commercial |
$1,970.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,642.07
|
| Rate for Payer: Mclaren Medicaid |
$385.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$574.72
|
| Rate for Payer: Meridian Medicaid |
$405.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$629.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$602.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.01
|
| Rate for Payer: Nomi Health Commercial |
$1,795.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,642.07
|
| Rate for Payer: PACE Senior Care Partners |
$519.99
|
| Rate for Payer: PACE SWMI |
$547.36
|
| Rate for Payer: PHP Commercial |
$1,861.01
|
| Rate for Payer: PHP Medicare Advantage |
$547.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,904.80
|
| Rate for Payer: Priority Health Medicare |
$552.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,523.84
|
| Rate for Payer: Railroad Medicare Medicare |
$547.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,926.69
|
| Rate for Payer: UHC Core |
$1,828.17
|
| Rate for Payer: UHC Exchange |
$547.36
|
| Rate for Payer: UHC Medicaid |
$385.99
|
| Rate for Payer: UHC Medicare Advantage |
$547.36
|
| Rate for Payer: UHCCP Medicaid |
$385.99
|
| Rate for Payer: VA VA |
$547.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,642.07
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
IP
|
$2,075.82
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,444.77 |
| Max. Negotiated Rate |
$1,868.24 |
| Rate for Payer: Aetna Commercial |
$1,764.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,714.42
|
| Rate for Payer: BCN Commercial |
$1,714.42
|
| Rate for Payer: Cash Price |
$1,660.66
|
| Rate for Payer: Cofinity Commercial |
$1,785.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,660.66
|
| Rate for Payer: Healthscope Commercial |
$1,868.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,556.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,764.45
|
| Rate for Payer: Nomi Health Commercial |
$1,702.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.87
|
| Rate for Payer: PHP Commercial |
$1,764.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,805.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,444.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,826.72
|
| Rate for Payer: UHC Core |
$1,733.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,556.87
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
OP
|
$2,075.82
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$365.97 |
| Max. Negotiated Rate |
$1,868.24 |
| Rate for Payer: Aetna Commercial |
$1,764.45
|
| Rate for Payer: Aetna Medicare |
$539.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$648.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$648.69
|
| Rate for Payer: BCBS Complete |
$384.23
|
| Rate for Payer: BCBS MAPPO |
$518.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,706.53
|
| Rate for Payer: BCN Commercial |
$1,706.53
|
| Rate for Payer: BCN Medicare Advantage |
$518.96
|
| Rate for Payer: Cash Price |
$1,660.66
|
| Rate for Payer: Cofinity Commercial |
$1,785.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,660.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$518.96
|
| Rate for Payer: Healthscope Commercial |
$1,868.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,556.87
|
| Rate for Payer: Mclaren Medicaid |
$365.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$544.90
|
| Rate for Payer: Meridian Medicaid |
$384.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$596.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$570.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,764.45
|
| Rate for Payer: Nomi Health Commercial |
$1,702.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.87
|
| Rate for Payer: PACE Senior Care Partners |
$493.01
|
| Rate for Payer: PACE SWMI |
$518.96
|
| Rate for Payer: PHP Commercial |
$1,764.45
|
| Rate for Payer: PHP Medicare Advantage |
$518.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,805.96
|
| Rate for Payer: Priority Health Medicare |
$524.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,444.77
|
| Rate for Payer: Railroad Medicare Medicare |
$518.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,826.72
|
| Rate for Payer: UHC Core |
$1,733.31
|
| Rate for Payer: UHC Exchange |
$518.96
|
| Rate for Payer: UHC Medicaid |
$365.97
|
| Rate for Payer: UHC Medicare Advantage |
$518.96
|
| Rate for Payer: UHCCP Medicaid |
$365.97
|
| Rate for Payer: VA VA |
$518.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,556.87
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
IP
|
$2,844.51
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,979.78 |
| Max. Negotiated Rate |
$2,560.06 |
| Rate for Payer: Aetna Commercial |
$2,417.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,349.28
|
| Rate for Payer: BCN Commercial |
$2,349.28
|
| Rate for Payer: Cash Price |
$2,275.61
|
| Rate for Payer: Cofinity Commercial |
$2,446.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,275.61
|
| Rate for Payer: Healthscope Commercial |
$2,560.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,133.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,417.83
|
| Rate for Payer: Nomi Health Commercial |
$2,332.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,133.38
|
| Rate for Payer: PHP Commercial |
$2,417.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,474.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,979.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,503.17
|
| Rate for Payer: UHC Core |
$2,375.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,133.38
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
OP
|
$2,844.51
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$501.49 |
| Max. Negotiated Rate |
$2,560.06 |
| Rate for Payer: Aetna Commercial |
$2,417.83
|
| Rate for Payer: Aetna Medicare |
$739.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$888.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$888.91
|
| Rate for Payer: BCBS Complete |
$526.52
|
| Rate for Payer: BCBS MAPPO |
$711.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,338.47
|
| Rate for Payer: BCN Commercial |
$2,338.47
|
| Rate for Payer: BCN Medicare Advantage |
$711.13
|
| Rate for Payer: Cash Price |
$2,275.61
|
| Rate for Payer: Cofinity Commercial |
$2,446.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,275.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.13
|
| Rate for Payer: Healthscope Commercial |
$2,560.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,133.38
|
| Rate for Payer: Mclaren Medicaid |
$501.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$746.68
|
| Rate for Payer: Meridian Medicaid |
$526.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$817.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$782.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,417.83
|
| Rate for Payer: Nomi Health Commercial |
$2,332.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,133.38
|
| Rate for Payer: PACE Senior Care Partners |
$675.57
|
| Rate for Payer: PACE SWMI |
$711.13
|
| Rate for Payer: PHP Commercial |
$2,417.83
|
| Rate for Payer: PHP Medicare Advantage |
$711.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$501.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,474.72
|
| Rate for Payer: Priority Health Medicare |
$718.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,979.78
|
| Rate for Payer: Railroad Medicare Medicare |
$711.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,503.17
|
| Rate for Payer: UHC Core |
$2,375.17
|
| Rate for Payer: UHC Exchange |
$711.13
|
| Rate for Payer: UHC Medicaid |
$501.49
|
| Rate for Payer: UHC Medicare Advantage |
$711.13
|
| Rate for Payer: UHCCP Medicaid |
$501.49
|
| Rate for Payer: VA VA |
$711.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,133.38
|
|
|
HC MR PELVIS W CON
|
Facility
|
IP
|
$2,288.04
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,592.48 |
| Max. Negotiated Rate |
$2,059.24 |
| Rate for Payer: Aetna Commercial |
$1,944.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.69
|
| Rate for Payer: BCN Commercial |
$1,889.69
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Commercial |
$1,967.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Healthscope Commercial |
$2,059.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,716.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Nomi Health Commercial |
$1,876.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,716.03
|
| Rate for Payer: PHP Commercial |
$1,944.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,990.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,592.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,013.48
|
| Rate for Payer: UHC Core |
$1,910.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,716.03
|
|
|
HC MR PELVIS W CON
|
Facility
|
OP
|
$2,288.04
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$403.38 |
| Max. Negotiated Rate |
$2,059.24 |
| Rate for Payer: Aetna Commercial |
$1,944.83
|
| Rate for Payer: Aetna Medicare |
$594.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$715.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$715.01
|
| Rate for Payer: BCBS Complete |
$423.52
|
| Rate for Payer: BCBS MAPPO |
$572.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,881.00
|
| Rate for Payer: BCN Commercial |
$1,881.00
|
| Rate for Payer: BCN Medicare Advantage |
$572.01
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Commercial |
$1,967.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.01
|
| Rate for Payer: Healthscope Commercial |
$2,059.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,716.03
|
| Rate for Payer: Mclaren Medicaid |
$403.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$600.61
|
| Rate for Payer: Meridian Medicaid |
$423.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$657.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$629.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Nomi Health Commercial |
$1,876.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,716.03
|
| Rate for Payer: PACE Senior Care Partners |
$543.41
|
| Rate for Payer: PACE SWMI |
$572.01
|
| Rate for Payer: PHP Commercial |
$1,944.83
|
| Rate for Payer: PHP Medicare Advantage |
$572.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,990.59
|
| Rate for Payer: Priority Health Medicare |
$577.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,592.48
|
| Rate for Payer: Railroad Medicare Medicare |
$572.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,013.48
|
| Rate for Payer: UHC Core |
$1,910.51
|
| Rate for Payer: UHC Exchange |
$572.01
|
| Rate for Payer: UHC Medicaid |
$403.38
|
| Rate for Payer: UHC Medicare Advantage |
$572.01
|
| Rate for Payer: UHCCP Medicaid |
$403.38
|
| Rate for Payer: VA VA |
$572.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,716.03
|
|
|
HC MR PELVIS WO CON
|
Facility
|
IP
|
$2,073.39
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,443.08 |
| Max. Negotiated Rate |
$1,866.05 |
| Rate for Payer: Aetna Commercial |
$1,762.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,712.41
|
| Rate for Payer: BCN Commercial |
$1,712.41
|
| Rate for Payer: Cash Price |
$1,658.71
|
| Rate for Payer: Cofinity Commercial |
$1,783.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.71
|
| Rate for Payer: Healthscope Commercial |
$1,866.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,555.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,762.38
|
| Rate for Payer: Nomi Health Commercial |
$1,700.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,555.04
|
| Rate for Payer: PHP Commercial |
$1,762.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,803.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,443.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,824.58
|
| Rate for Payer: UHC Core |
$1,731.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,555.04
|
|
|
HC MR PELVIS WO CON
|
Facility
|
OP
|
$2,073.39
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$365.54 |
| Max. Negotiated Rate |
$1,866.05 |
| Rate for Payer: Aetna Commercial |
$1,762.38
|
| Rate for Payer: Aetna Medicare |
$539.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$647.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$647.93
|
| Rate for Payer: BCBS Complete |
$383.78
|
| Rate for Payer: BCBS MAPPO |
$518.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.53
|
| Rate for Payer: BCN Commercial |
$1,704.53
|
| Rate for Payer: BCN Medicare Advantage |
$518.35
|
| Rate for Payer: Cash Price |
$1,658.71
|
| Rate for Payer: Cofinity Commercial |
$1,783.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$518.35
|
| Rate for Payer: Healthscope Commercial |
$1,866.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,555.04
|
| Rate for Payer: Mclaren Medicaid |
$365.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$544.26
|
| Rate for Payer: Meridian Medicaid |
$383.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$596.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$570.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,762.38
|
| Rate for Payer: Nomi Health Commercial |
$1,700.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,555.04
|
| Rate for Payer: PACE Senior Care Partners |
$492.43
|
| Rate for Payer: PACE SWMI |
$518.35
|
| Rate for Payer: PHP Commercial |
$1,762.38
|
| Rate for Payer: PHP Medicare Advantage |
$518.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,803.85
|
| Rate for Payer: Priority Health Medicare |
$523.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,443.08
|
| Rate for Payer: Railroad Medicare Medicare |
$518.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,824.58
|
| Rate for Payer: UHC Core |
$1,731.28
|
| Rate for Payer: UHC Exchange |
$518.35
|
| Rate for Payer: UHC Medicaid |
$365.54
|
| Rate for Payer: UHC Medicare Advantage |
$518.35
|
| Rate for Payer: UHCCP Medicaid |
$365.54
|
| Rate for Payer: VA VA |
$518.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,555.04
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
IP
|
$3,110.14
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,164.66 |
| Max. Negotiated Rate |
$2,799.13 |
| Rate for Payer: Aetna Commercial |
$2,643.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,568.66
|
| Rate for Payer: BCN Commercial |
$2,568.66
|
| Rate for Payer: Cash Price |
$2,488.11
|
| Rate for Payer: Cofinity Commercial |
$2,674.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,488.11
|
| Rate for Payer: Healthscope Commercial |
$2,799.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,332.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,643.62
|
| Rate for Payer: Nomi Health Commercial |
$2,550.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,332.61
|
| Rate for Payer: PHP Commercial |
$2,643.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,705.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,164.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,736.92
|
| Rate for Payer: UHC Core |
$2,596.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,332.61
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
OP
|
$3,110.14
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$548.32 |
| Max. Negotiated Rate |
$2,799.13 |
| Rate for Payer: Aetna Commercial |
$2,643.62
|
| Rate for Payer: Aetna Medicare |
$808.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$971.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$971.92
|
| Rate for Payer: BCBS Complete |
$575.69
|
| Rate for Payer: BCBS MAPPO |
$777.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,556.85
|
| Rate for Payer: BCN Commercial |
$2,556.85
|
| Rate for Payer: BCN Medicare Advantage |
$777.53
|
| Rate for Payer: Cash Price |
$2,488.11
|
| Rate for Payer: Cofinity Commercial |
$2,674.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,488.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$777.53
|
| Rate for Payer: Healthscope Commercial |
$2,799.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,332.61
|
| Rate for Payer: Mclaren Medicaid |
$548.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$816.41
|
| Rate for Payer: Meridian Medicaid |
$575.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$894.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$855.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,643.62
|
| Rate for Payer: Nomi Health Commercial |
$2,550.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,332.61
|
| Rate for Payer: PACE Senior Care Partners |
$738.66
|
| Rate for Payer: PACE SWMI |
$777.53
|
| Rate for Payer: PHP Commercial |
$2,643.62
|
| Rate for Payer: PHP Medicare Advantage |
$777.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$548.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,705.82
|
| Rate for Payer: Priority Health Medicare |
$785.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,164.66
|
| Rate for Payer: Railroad Medicare Medicare |
$777.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,736.92
|
| Rate for Payer: UHC Core |
$2,596.97
|
| Rate for Payer: UHC Exchange |
$777.53
|
| Rate for Payer: UHC Medicaid |
$548.32
|
| Rate for Payer: UHC Medicare Advantage |
$777.53
|
| Rate for Payer: UHCCP Medicaid |
$548.32
|
| Rate for Payer: VA VA |
$777.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,332.61
|
|
|
HC MR SAFETY DETERMINATION PHYS/QHP
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
61000098
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Aetna Commercial |
$224.40
|
| Rate for Payer: Aetna Medicare |
$68.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.50
|
| Rate for Payer: BCBS Complete |
$48.87
|
| Rate for Payer: BCBS MAPPO |
$66.00
|
| Rate for Payer: BCBS Trust/PPO |
$217.03
|
| Rate for Payer: BCN Commercial |
$217.03
|
| Rate for Payer: BCN Medicare Advantage |
$66.00
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cofinity Commercial |
$227.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.00
|
| Rate for Payer: Healthscope Commercial |
$237.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.00
|
| Rate for Payer: Mclaren Medicaid |
$46.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.30
|
| Rate for Payer: Meridian Medicaid |
$48.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.40
|
| Rate for Payer: Nomi Health Commercial |
$216.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.00
|
| Rate for Payer: PACE Senior Care Partners |
$62.70
|
| Rate for Payer: PACE SWMI |
$66.00
|
| Rate for Payer: PHP Commercial |
$224.40
|
| Rate for Payer: PHP Medicare Advantage |
$66.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$229.68
|
| Rate for Payer: Priority Health Medicare |
$66.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.74
|
| Rate for Payer: Railroad Medicare Medicare |
$66.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.32
|
| Rate for Payer: UHC Core |
$220.44
|
| Rate for Payer: UHC Exchange |
$66.00
|
| Rate for Payer: UHC Medicaid |
$46.54
|
| Rate for Payer: UHC Medicare Advantage |
$66.00
|
| Rate for Payer: UHCCP Medicaid |
$46.54
|
| Rate for Payer: VA VA |
$66.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.00
|
|
|
HC MR SAFETY DETERMINATION PHYS/QHP
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
61000098
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$183.74 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Aetna Commercial |
$224.40
|
| Rate for Payer: BCBS Trust/PPO |
$218.04
|
| Rate for Payer: BCN Commercial |
$218.04
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cofinity Commercial |
$227.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.20
|
| Rate for Payer: Healthscope Commercial |
$237.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.40
|
| Rate for Payer: Nomi Health Commercial |
$216.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.00
|
| Rate for Payer: PHP Commercial |
$224.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$229.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.32
|
| Rate for Payer: UHC Core |
$220.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.00
|
|
|
HC MR SAFETY IMPLANT ELECTRONICS PREP
|
Facility
|
IP
|
$199.92
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
61000095
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$139.14 |
| Max. Negotiated Rate |
$179.93 |
| Rate for Payer: Aetna Commercial |
$169.93
|
| Rate for Payer: BCBS Trust/PPO |
$165.11
|
| Rate for Payer: BCN Commercial |
$165.11
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$171.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Healthscope Commercial |
$179.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.93
|
| Rate for Payer: Nomi Health Commercial |
$163.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.94
|
| Rate for Payer: PHP Commercial |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.93
|
| Rate for Payer: UHC Core |
$166.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.94
|
|
|
HC MR SAFETY IMPLANT ELECTRONICS PREP
|
Facility
|
OP
|
$199.92
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
61000095
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$179.93 |
| Rate for Payer: Aetna Commercial |
$169.93
|
| Rate for Payer: Aetna Medicare |
$51.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.48
|
| Rate for Payer: BCBS Complete |
$37.01
|
| Rate for Payer: BCBS MAPPO |
$49.98
|
| Rate for Payer: BCBS Trust/PPO |
$164.35
|
| Rate for Payer: BCN Commercial |
$164.35
|
| Rate for Payer: BCN Medicare Advantage |
$49.98
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$171.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.98
|
| Rate for Payer: Healthscope Commercial |
$179.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.94
|
| Rate for Payer: Mclaren Medicaid |
$35.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.48
|
| Rate for Payer: Meridian Medicaid |
$37.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.93
|
| Rate for Payer: Nomi Health Commercial |
$163.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.94
|
| Rate for Payer: PACE Senior Care Partners |
$47.48
|
| Rate for Payer: PACE SWMI |
$49.98
|
| Rate for Payer: PHP Commercial |
$169.93
|
| Rate for Payer: PHP Medicare Advantage |
$49.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.93
|
| Rate for Payer: Priority Health Medicare |
$50.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.14
|
| Rate for Payer: Railroad Medicare Medicare |
$49.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.93
|
| Rate for Payer: UHC Core |
$166.93
|
| Rate for Payer: UHC Exchange |
$49.98
|
| Rate for Payer: UHC Medicaid |
$35.25
|
| Rate for Payer: UHC Medicare Advantage |
$49.98
|
| Rate for Payer: UHCCP Medicaid |
$35.25
|
| Rate for Payer: VA VA |
$49.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.94
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF 1ST 15 MIN.
|
Facility
|
OP
|
$54.06
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
61000094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna Medicare |
$14.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.89
|
| Rate for Payer: BCBS Complete |
$10.01
|
| Rate for Payer: BCBS MAPPO |
$13.52
|
| Rate for Payer: BCBS Trust/PPO |
$44.44
|
| Rate for Payer: BCN Commercial |
$44.44
|
| Rate for Payer: BCN Medicare Advantage |
$13.52
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.52
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.55
|
| Rate for Payer: Mclaren Medicaid |
$9.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.19
|
| Rate for Payer: Meridian Medicaid |
$10.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.95
|
| Rate for Payer: Nomi Health Commercial |
$44.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.55
|
| Rate for Payer: PACE Senior Care Partners |
$12.84
|
| Rate for Payer: PACE SWMI |
$13.52
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicare Advantage |
$13.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.03
|
| Rate for Payer: Priority Health Medicare |
$13.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.63
|
| Rate for Payer: Railroad Medicare Medicare |
$13.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.57
|
| Rate for Payer: UHC Core |
$45.14
|
| Rate for Payer: UHC Exchange |
$13.52
|
| Rate for Payer: UHC Medicaid |
$9.53
|
| Rate for Payer: UHC Medicare Advantage |
$13.52
|
| Rate for Payer: UHCCP Medicaid |
$9.53
|
| Rate for Payer: VA VA |
$13.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.55
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF 1ST 15 MIN.
|
Facility
|
IP
|
$54.06
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
61000094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: BCBS Trust/PPO |
$44.65
|
| Rate for Payer: BCN Commercial |
$44.65
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.95
|
| Rate for Payer: Nomi Health Commercial |
$44.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.55
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.57
|
| Rate for Payer: UHC Core |
$45.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.55
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF EA ADD 30 MIN.
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
61000097
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$190.70 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Aetna Commercial |
$232.90
|
| Rate for Payer: BCBS Trust/PPO |
$226.30
|
| Rate for Payer: BCN Commercial |
$226.30
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$235.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Healthscope Commercial |
$246.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: Nomi Health Commercial |
$224.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.50
|
| Rate for Payer: PHP Commercial |
$232.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$238.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.12
|
| Rate for Payer: UHC Core |
$228.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.50
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF EA ADD 30 MIN.
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
61000097
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$48.31 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Aetna Commercial |
$232.90
|
| Rate for Payer: Aetna Medicare |
$71.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.62
|
| Rate for Payer: BCBS Complete |
$50.72
|
| Rate for Payer: BCBS MAPPO |
$68.50
|
| Rate for Payer: BCBS Trust/PPO |
$225.26
|
| Rate for Payer: BCN Commercial |
$225.26
|
| Rate for Payer: BCN Medicare Advantage |
$68.50
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$235.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.50
|
| Rate for Payer: Healthscope Commercial |
$246.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.50
|
| Rate for Payer: Mclaren Medicaid |
$48.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.92
|
| Rate for Payer: Meridian Medicaid |
$50.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: Nomi Health Commercial |
$224.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.50
|
| Rate for Payer: PACE Senior Care Partners |
$65.08
|
| Rate for Payer: PACE SWMI |
$68.50
|
| Rate for Payer: PHP Commercial |
$232.90
|
| Rate for Payer: PHP Medicare Advantage |
$68.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$238.38
|
| Rate for Payer: Priority Health Medicare |
$69.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.70
|
| Rate for Payer: Railroad Medicare Medicare |
$68.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.12
|
| Rate for Payer: UHC Core |
$228.79
|
| Rate for Payer: UHC Exchange |
$68.50
|
| Rate for Payer: UHC Medicaid |
$48.31
|
| Rate for Payer: UHC Medicare Advantage |
$68.50
|
| Rate for Payer: UHCCP Medicaid |
$48.31
|
| Rate for Payer: VA VA |
$68.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.50
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
OP
|
$1,938.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$341.70 |
| Max. Negotiated Rate |
$1,744.34 |
| Rate for Payer: Aetna Commercial |
$1,647.44
|
| Rate for Payer: Aetna Medicare |
$503.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$605.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$605.67
|
| Rate for Payer: BCBS Complete |
$358.75
|
| Rate for Payer: BCBS MAPPO |
$484.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.36
|
| Rate for Payer: BCN Commercial |
$1,593.36
|
| Rate for Payer: BCN Medicare Advantage |
$484.54
|
| Rate for Payer: Cash Price |
$1,550.53
|
| Rate for Payer: Cofinity Commercial |
$1,666.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.54
|
| Rate for Payer: Healthscope Commercial |
$1,744.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,453.62
|
| Rate for Payer: Mclaren Medicaid |
$341.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$508.77
|
| Rate for Payer: Meridian Medicaid |
$358.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$557.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$532.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.44
|
| Rate for Payer: Nomi Health Commercial |
$1,589.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,453.62
|
| Rate for Payer: PACE Senior Care Partners |
$460.31
|
| Rate for Payer: PACE SWMI |
$484.54
|
| Rate for Payer: PHP Commercial |
$1,647.44
|
| Rate for Payer: PHP Medicare Advantage |
$484.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,686.20
|
| Rate for Payer: Priority Health Medicare |
$489.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,348.96
|
| Rate for Payer: Railroad Medicare Medicare |
$484.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,705.58
|
| Rate for Payer: UHC Core |
$1,618.36
|
| Rate for Payer: UHC Exchange |
$484.54
|
| Rate for Payer: UHC Medicaid |
$341.70
|
| Rate for Payer: UHC Medicare Advantage |
$484.54
|
| Rate for Payer: UHCCP Medicaid |
$341.70
|
| Rate for Payer: VA VA |
$484.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,453.62
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
IP
|
$1,938.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,348.96 |
| Max. Negotiated Rate |
$1,744.34 |
| Rate for Payer: Aetna Commercial |
$1,647.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,600.73
|
| Rate for Payer: BCN Commercial |
$1,600.73
|
| Rate for Payer: Cash Price |
$1,550.53
|
| Rate for Payer: Cofinity Commercial |
$1,666.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.53
|
| Rate for Payer: Healthscope Commercial |
$1,744.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,453.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.44
|
| Rate for Payer: Nomi Health Commercial |
$1,589.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,453.62
|
| Rate for Payer: PHP Commercial |
$1,647.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,686.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,348.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,705.58
|
| Rate for Payer: UHC Core |
$1,618.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,453.62
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
OP
|
$2,368.79
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$417.62 |
| Max. Negotiated Rate |
$2,131.91 |
| Rate for Payer: Aetna Commercial |
$2,013.47
|
| Rate for Payer: Aetna Medicare |
$615.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$740.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$740.25
|
| Rate for Payer: BCBS Complete |
$438.46
|
| Rate for Payer: BCBS MAPPO |
$592.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,947.38
|
| Rate for Payer: BCN Commercial |
$1,947.38
|
| Rate for Payer: BCN Medicare Advantage |
$592.20
|
| Rate for Payer: Cash Price |
$1,895.03
|
| Rate for Payer: Cofinity Commercial |
$2,037.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,895.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.20
|
| Rate for Payer: Healthscope Commercial |
$2,131.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,776.59
|
| Rate for Payer: Mclaren Medicaid |
$417.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.81
|
| Rate for Payer: Meridian Medicaid |
$438.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$681.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$651.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,013.47
|
| Rate for Payer: Nomi Health Commercial |
$1,942.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,776.59
|
| Rate for Payer: PACE Senior Care Partners |
$562.59
|
| Rate for Payer: PACE SWMI |
$592.20
|
| Rate for Payer: PHP Commercial |
$2,013.47
|
| Rate for Payer: PHP Medicare Advantage |
$592.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$417.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,060.85
|
| Rate for Payer: Priority Health Medicare |
$598.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,648.68
|
| Rate for Payer: Railroad Medicare Medicare |
$592.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,084.54
|
| Rate for Payer: UHC Core |
$1,977.94
|
| Rate for Payer: UHC Exchange |
$592.20
|
| Rate for Payer: UHC Medicaid |
$417.62
|
| Rate for Payer: UHC Medicare Advantage |
$592.20
|
| Rate for Payer: UHCCP Medicaid |
$417.62
|
| Rate for Payer: VA VA |
$592.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,776.59
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
IP
|
$2,368.79
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,648.68 |
| Max. Negotiated Rate |
$2,131.91 |
| Rate for Payer: Aetna Commercial |
$2,013.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,956.38
|
| Rate for Payer: BCN Commercial |
$1,956.38
|
| Rate for Payer: Cash Price |
$1,895.03
|
| Rate for Payer: Cofinity Commercial |
$2,037.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,895.03
|
| Rate for Payer: Healthscope Commercial |
$2,131.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,776.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,013.47
|
| Rate for Payer: Nomi Health Commercial |
$1,942.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,776.59
|
| Rate for Payer: PHP Commercial |
$2,013.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,060.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,648.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,084.54
|
| Rate for Payer: UHC Core |
$1,977.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,776.59
|
|
|
HC MR SPINE CERVICAL W CON LTD
|
Facility
|
OP
|
$1,183.98
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200003
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$208.74 |
| Max. Negotiated Rate |
$1,065.58 |
| Rate for Payer: Aetna Commercial |
$1,006.38
|
| Rate for Payer: Aetna Medicare |
$307.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$369.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$369.99
|
| Rate for Payer: BCBS Complete |
$219.15
|
| Rate for Payer: BCBS MAPPO |
$296.00
|
| Rate for Payer: BCBS Trust/PPO |
$973.35
|
| Rate for Payer: BCN Commercial |
$973.35
|
| Rate for Payer: BCN Medicare Advantage |
$296.00
|
| Rate for Payer: Cash Price |
$947.18
|
| Rate for Payer: Cofinity Commercial |
$1,018.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$947.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.00
|
| Rate for Payer: Healthscope Commercial |
$1,065.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.99
|
| Rate for Payer: Mclaren Medicaid |
$208.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.79
|
| Rate for Payer: Meridian Medicaid |
$219.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$325.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,006.38
|
| Rate for Payer: Nomi Health Commercial |
$970.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$887.99
|
| Rate for Payer: PACE Senior Care Partners |
$281.20
|
| Rate for Payer: PACE SWMI |
$296.00
|
| Rate for Payer: PHP Commercial |
$1,006.38
|
| Rate for Payer: PHP Medicare Advantage |
$296.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,030.06
|
| Rate for Payer: Priority Health Medicare |
$298.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$824.05
|
| Rate for Payer: Railroad Medicare Medicare |
$296.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,041.90
|
| Rate for Payer: UHC Core |
$988.62
|
| Rate for Payer: UHC Exchange |
$296.00
|
| Rate for Payer: UHC Medicaid |
$208.74
|
| Rate for Payer: UHC Medicare Advantage |
$296.00
|
| Rate for Payer: UHCCP Medicaid |
$208.74
|
| Rate for Payer: VA VA |
$296.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.99
|
|
