|
HC MR BRAIN WO CON
|
Facility
|
OP
|
$2,072.90
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
61100001
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$1,865.61 |
| Rate for Payer: Aetna Commercial |
$1,761.96
|
| Rate for Payer: Aetna Medicare |
$538.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$647.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$647.78
|
| Rate for Payer: BCBS Complete |
$183.51
|
| Rate for Payer: BCBS MAPPO |
$518.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.13
|
| Rate for Payer: BCN Commercial |
$1,611.68
|
| Rate for Payer: BCN Medicare Advantage |
$518.23
|
| Rate for Payer: Cash Price |
$1,658.32
|
| Rate for Payer: Cash Price |
$1,658.32
|
| Rate for Payer: Cofinity Commercial |
$1,782.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$518.23
|
| Rate for Payer: Healthscope Commercial |
$1,865.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,554.67
|
| Rate for Payer: Mclaren Medicaid |
$174.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$544.14
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.96
|
| Rate for Payer: Nomi Health Commercial |
$1,699.78
|
| Rate for Payer: PACE Senior Care Partners |
$492.31
|
| Rate for Payer: PACE SWMI |
$518.23
|
| Rate for Payer: PHP Commercial |
$1,761.96
|
| Rate for Payer: PHP Medicare Advantage |
$518.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.38
|
| Rate for Payer: Priority Health HMO/PPO |
$1,803.42
|
| Rate for Payer: Priority Health Medicare |
$523.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,388.84
|
| Rate for Payer: Railroad Medicare Medicare |
$518.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,824.15
|
| Rate for Payer: UHC Core |
$1,730.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$518.23
|
| Rate for Payer: UHC Exchange |
$518.23
|
| Rate for Payer: UHC Medicare Advantage |
$518.23
|
| Rate for Payer: UHCCP Medicaid |
$174.76
|
| Rate for Payer: VA VA |
$518.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,554.67
|
|
|
HC MR BRAIN WO W CON
|
Facility
|
IP
|
$3,165.73
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
61100003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,057.72 |
| Max. Negotiated Rate |
$2,849.16 |
| Rate for Payer: Aetna Commercial |
$2,690.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,584.19
|
| Rate for Payer: BCN Commercial |
$2,446.48
|
| Rate for Payer: Cash Price |
$2,532.58
|
| Rate for Payer: Cofinity Commercial |
$2,722.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,532.58
|
| Rate for Payer: Healthscope Commercial |
$2,849.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,374.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,690.87
|
| Rate for Payer: Nomi Health Commercial |
$2,595.90
|
| Rate for Payer: PHP Commercial |
$2,690.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,057.72
|
| Rate for Payer: Priority Health HMO/PPO |
$2,754.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,121.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,785.84
|
| Rate for Payer: UHC Core |
$2,643.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,374.30
|
|
|
HC MR BRAIN WO W CON
|
Facility
|
OP
|
$3,165.73
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
61100003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$258.20 |
| Max. Negotiated Rate |
$2,849.16 |
| Rate for Payer: Aetna Commercial |
$2,690.87
|
| Rate for Payer: Aetna Medicare |
$823.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$989.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$989.29
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$791.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,602.55
|
| Rate for Payer: BCN Commercial |
$2,461.36
|
| Rate for Payer: BCN Medicare Advantage |
$791.43
|
| Rate for Payer: Cash Price |
$2,532.58
|
| Rate for Payer: Cash Price |
$2,532.58
|
| Rate for Payer: Cofinity Commercial |
$2,722.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,532.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$791.43
|
| Rate for Payer: Healthscope Commercial |
$2,849.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,374.30
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$831.00
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$910.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,690.87
|
| Rate for Payer: Nomi Health Commercial |
$2,595.90
|
| Rate for Payer: PACE Senior Care Partners |
$751.86
|
| Rate for Payer: PACE SWMI |
$791.43
|
| Rate for Payer: PHP Commercial |
$2,690.87
|
| Rate for Payer: PHP Medicare Advantage |
$791.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,057.72
|
| Rate for Payer: Priority Health HMO/PPO |
$2,754.19
|
| Rate for Payer: Priority Health Medicare |
$799.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,121.04
|
| Rate for Payer: Railroad Medicare Medicare |
$791.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,785.84
|
| Rate for Payer: UHC Core |
$2,643.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$791.43
|
| Rate for Payer: UHC Exchange |
$791.43
|
| Rate for Payer: UHC Medicare Advantage |
$791.43
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$791.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,374.30
|
|
|
HC MR BREAST ABBREVIATED WO W CON
|
Facility
|
OP
|
$289.45
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$68.74 |
| Max. Negotiated Rate |
$260.50 |
| Rate for Payer: Aetna Commercial |
$246.03
|
| Rate for Payer: Aetna Medicare |
$75.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.45
|
| Rate for Payer: BCBS Complete |
$115.78
|
| Rate for Payer: BCBS MAPPO |
$72.36
|
| Rate for Payer: BCBS Trust/PPO |
$237.96
|
| Rate for Payer: BCN Commercial |
$225.05
|
| Rate for Payer: BCN Medicare Advantage |
$72.36
|
| Rate for Payer: Cash Price |
$231.56
|
| Rate for Payer: Cofinity Commercial |
$248.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.36
|
| Rate for Payer: Healthscope Commercial |
$260.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.03
|
| Rate for Payer: Nomi Health Commercial |
$237.35
|
| Rate for Payer: PACE Senior Care Partners |
$68.74
|
| Rate for Payer: PACE SWMI |
$72.36
|
| Rate for Payer: PHP Commercial |
$246.03
|
| Rate for Payer: PHP Medicare Advantage |
$72.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.14
|
| Rate for Payer: Priority Health HMO/PPO |
$251.82
|
| Rate for Payer: Priority Health Medicare |
$73.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.93
|
| Rate for Payer: Railroad Medicare Medicare |
$72.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.72
|
| Rate for Payer: UHC Core |
$241.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.36
|
| Rate for Payer: UHC Exchange |
$72.36
|
| Rate for Payer: UHC Medicare Advantage |
$72.36
|
| Rate for Payer: VA VA |
$72.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.09
|
|
|
HC MR BREAST ABBREVIATED WO W CON
|
Facility
|
IP
|
$289.45
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$188.14 |
| Max. Negotiated Rate |
$260.50 |
| Rate for Payer: Aetna Commercial |
$246.03
|
| Rate for Payer: BCBS Trust/PPO |
$236.28
|
| Rate for Payer: BCN Commercial |
$223.69
|
| Rate for Payer: Cash Price |
$231.56
|
| Rate for Payer: Cofinity Commercial |
$248.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.56
|
| Rate for Payer: Healthscope Commercial |
$260.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.03
|
| Rate for Payer: Nomi Health Commercial |
$237.35
|
| Rate for Payer: PHP Commercial |
$246.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.14
|
| Rate for Payer: Priority Health HMO/PPO |
$251.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.72
|
| Rate for Payer: UHC Core |
$241.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.09
|
|
|
HC MR BREAST BIL SCREEN W CON
|
Facility
|
IP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.44 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.75
|
| Rate for Payer: BCN Commercial |
$954.04
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$925.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.35
|
| Rate for Payer: Nomi Health Commercial |
$1,012.31
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1,074.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$827.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.39
|
| Rate for Payer: UHC Core |
$1,030.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$925.90
|
|
|
HC MR BREAST BIL SCREEN W CON
|
Facility
|
OP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$258.20 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: Aetna Medicare |
$320.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$385.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$385.79
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$308.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.91
|
| Rate for Payer: BCN Commercial |
$959.85
|
| Rate for Payer: BCN Medicare Advantage |
$308.63
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.63
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$925.90
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.06
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$354.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.35
|
| Rate for Payer: Nomi Health Commercial |
$1,012.31
|
| Rate for Payer: PACE Senior Care Partners |
$293.20
|
| Rate for Payer: PACE SWMI |
$308.63
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: PHP Medicare Advantage |
$308.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1,074.04
|
| Rate for Payer: Priority Health Medicare |
$311.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$827.14
|
| Rate for Payer: Railroad Medicare Medicare |
$308.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.39
|
| Rate for Payer: UHC Core |
$1,030.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.63
|
| Rate for Payer: UHC Exchange |
$308.63
|
| Rate for Payer: UHC Medicare Advantage |
$308.63
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$308.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$925.90
|
|
|
HC MR BREAST BIL SCREEN WO W CON
|
Facility
|
OP
|
$1,259.22
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$258.20 |
| Max. Negotiated Rate |
$1,133.30 |
| Rate for Payer: Aetna Commercial |
$1,070.34
|
| Rate for Payer: Aetna Medicare |
$327.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$393.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$393.51
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$314.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,035.20
|
| Rate for Payer: BCN Commercial |
$979.04
|
| Rate for Payer: BCN Medicare Advantage |
$314.81
|
| Rate for Payer: Cash Price |
$1,007.38
|
| Rate for Payer: Cash Price |
$1,007.38
|
| Rate for Payer: Cofinity Commercial |
$1,082.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.81
|
| Rate for Payer: Healthscope Commercial |
$1,133.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.41
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.55
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.34
|
| Rate for Payer: Nomi Health Commercial |
$1,032.56
|
| Rate for Payer: PACE Senior Care Partners |
$299.06
|
| Rate for Payer: PACE SWMI |
$314.81
|
| Rate for Payer: PHP Commercial |
$1,070.34
|
| Rate for Payer: PHP Medicare Advantage |
$314.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,095.52
|
| Rate for Payer: Priority Health Medicare |
$317.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$843.68
|
| Rate for Payer: Railroad Medicare Medicare |
$314.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,108.11
|
| Rate for Payer: UHC Core |
$1,051.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.81
|
| Rate for Payer: UHC Exchange |
$314.81
|
| Rate for Payer: UHC Medicare Advantage |
$314.81
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$314.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.41
|
|
|
HC MR BREAST BIL SCREEN WO W CON
|
Facility
|
IP
|
$1,259.22
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$818.49 |
| Max. Negotiated Rate |
$1,133.30 |
| Rate for Payer: Aetna Commercial |
$1,070.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,027.90
|
| Rate for Payer: BCN Commercial |
$973.13
|
| Rate for Payer: Cash Price |
$1,007.38
|
| Rate for Payer: Cofinity Commercial |
$1,082.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.38
|
| Rate for Payer: Healthscope Commercial |
$1,133.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.34
|
| Rate for Payer: Nomi Health Commercial |
$1,032.56
|
| Rate for Payer: PHP Commercial |
$1,070.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,095.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$843.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,108.11
|
| Rate for Payer: UHC Core |
$1,051.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.41
|
|
|
HC MR BREAST BIL W CON
|
Facility
|
OP
|
$2,132.92
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$258.20 |
| Max. Negotiated Rate |
$1,919.63 |
| Rate for Payer: Aetna Commercial |
$1,812.98
|
| Rate for Payer: Aetna Medicare |
$554.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$666.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$666.54
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$533.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.47
|
| Rate for Payer: BCN Commercial |
$1,658.35
|
| Rate for Payer: BCN Medicare Advantage |
$533.23
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$1,834.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$533.23
|
| Rate for Payer: Healthscope Commercial |
$1,919.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,599.69
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$559.89
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$613.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,812.98
|
| Rate for Payer: Nomi Health Commercial |
$1,748.99
|
| Rate for Payer: PACE Senior Care Partners |
$506.57
|
| Rate for Payer: PACE SWMI |
$533.23
|
| Rate for Payer: PHP Commercial |
$1,812.98
|
| Rate for Payer: PHP Medicare Advantage |
$533.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,855.64
|
| Rate for Payer: Priority Health Medicare |
$538.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,429.06
|
| Rate for Payer: Railroad Medicare Medicare |
$533.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,876.97
|
| Rate for Payer: UHC Core |
$1,780.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$533.23
|
| Rate for Payer: UHC Exchange |
$533.23
|
| Rate for Payer: UHC Medicare Advantage |
$533.23
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$533.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,599.69
|
|
|
HC MR BREAST BIL W CON
|
Facility
|
IP
|
$2,132.92
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,386.40 |
| Max. Negotiated Rate |
$1,919.63 |
| Rate for Payer: Aetna Commercial |
$1,812.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,741.10
|
| Rate for Payer: BCN Commercial |
$1,648.32
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$1,834.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.34
|
| Rate for Payer: Healthscope Commercial |
$1,919.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,599.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,812.98
|
| Rate for Payer: Nomi Health Commercial |
$1,748.99
|
| Rate for Payer: PHP Commercial |
$1,812.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,855.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,429.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,876.97
|
| Rate for Payer: UHC Core |
$1,780.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,599.69
|
|
|
HC MR BREAST BIL WO W CON
|
Facility
|
IP
|
$2,175.58
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,414.13 |
| Max. Negotiated Rate |
$1,958.02 |
| Rate for Payer: Aetna Commercial |
$1,849.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,775.93
|
| Rate for Payer: BCN Commercial |
$1,681.29
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cofinity Commercial |
$1,871.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.46
|
| Rate for Payer: Healthscope Commercial |
$1,958.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,631.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,849.24
|
| Rate for Payer: Nomi Health Commercial |
$1,783.98
|
| Rate for Payer: PHP Commercial |
$1,849.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,892.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,457.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,914.51
|
| Rate for Payer: UHC Core |
$1,816.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.68
|
|
|
HC MR BREAST BIL WO W CON
|
Facility
|
OP
|
$2,175.58
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$516.70 |
| Max. Negotiated Rate |
$1,958.02 |
| Rate for Payer: Aetna Commercial |
$1,849.24
|
| Rate for Payer: Aetna Medicare |
$565.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$679.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$679.87
|
| Rate for Payer: BCBS Complete |
$870.23
|
| Rate for Payer: BCBS MAPPO |
$543.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,788.54
|
| Rate for Payer: BCN Commercial |
$1,691.51
|
| Rate for Payer: BCN Medicare Advantage |
$543.89
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cofinity Commercial |
$1,871.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.89
|
| Rate for Payer: Healthscope Commercial |
$1,958.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,631.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$625.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,849.24
|
| Rate for Payer: Nomi Health Commercial |
$1,783.98
|
| Rate for Payer: PACE Senior Care Partners |
$516.70
|
| Rate for Payer: PACE SWMI |
$543.89
|
| Rate for Payer: PHP Commercial |
$1,849.24
|
| Rate for Payer: PHP Medicare Advantage |
$543.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,892.75
|
| Rate for Payer: Priority Health Medicare |
$549.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,457.64
|
| Rate for Payer: Railroad Medicare Medicare |
$543.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,914.51
|
| Rate for Payer: UHC Core |
$1,816.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$543.89
|
| Rate for Payer: UHC Exchange |
$543.89
|
| Rate for Payer: UHC Medicare Advantage |
$543.89
|
| Rate for Payer: VA VA |
$543.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.68
|
|
|
HC MR BREAST CAD
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS C8937
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.01
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: BCBS MAPPO |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$34.22
|
| Rate for Payer: BCN Commercial |
$32.36
|
| Rate for Payer: BCN Medicare Advantage |
$10.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Senior Care Partners |
$9.88
|
| Rate for Payer: PACE SWMI |
$10.40
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Medicare |
$10.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: Railroad Medicare Medicare |
$10.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.40
|
| Rate for Payer: UHC Exchange |
$10.40
|
| Rate for Payer: UHC Medicare Advantage |
$10.40
|
| Rate for Payer: VA VA |
$10.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC MR BREAST CAD
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS C8937
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.97
|
| Rate for Payer: BCN Commercial |
$32.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC MR BREAST UNI SCREEN W CON
|
Facility
|
IP
|
$908.41
|
|
|
Service Code
|
HCPCS C8903
|
| Hospital Charge Code |
61000085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$590.47 |
| Max. Negotiated Rate |
$817.57 |
| Rate for Payer: Aetna Commercial |
$772.15
|
| Rate for Payer: BCBS Trust/PPO |
$741.54
|
| Rate for Payer: BCN Commercial |
$702.02
|
| Rate for Payer: Cash Price |
$726.73
|
| Rate for Payer: Cofinity Commercial |
$781.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.73
|
| Rate for Payer: Healthscope Commercial |
$817.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$681.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$772.15
|
| Rate for Payer: Nomi Health Commercial |
$744.90
|
| Rate for Payer: PHP Commercial |
$772.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.47
|
| Rate for Payer: Priority Health HMO/PPO |
$790.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$608.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$799.40
|
| Rate for Payer: UHC Core |
$758.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$681.31
|
|
|
HC MR BREAST UNI SCREEN W CON
|
Facility
|
OP
|
$908.41
|
|
|
Service Code
|
HCPCS C8903
|
| Hospital Charge Code |
61000085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$817.57 |
| Rate for Payer: Aetna Commercial |
$772.15
|
| Rate for Payer: Aetna Medicare |
$236.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.88
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$227.10
|
| Rate for Payer: BCBS Trust/PPO |
$746.80
|
| Rate for Payer: BCN Commercial |
$706.29
|
| Rate for Payer: BCN Medicare Advantage |
$227.10
|
| Rate for Payer: Cash Price |
$726.73
|
| Rate for Payer: Cash Price |
$726.73
|
| Rate for Payer: Cofinity Commercial |
$781.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.10
|
| Rate for Payer: Healthscope Commercial |
$817.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$681.31
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.46
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$772.15
|
| Rate for Payer: Nomi Health Commercial |
$744.90
|
| Rate for Payer: PACE Senior Care Partners |
$215.75
|
| Rate for Payer: PACE SWMI |
$227.10
|
| Rate for Payer: PHP Commercial |
$772.15
|
| Rate for Payer: PHP Medicare Advantage |
$227.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.47
|
| Rate for Payer: Priority Health HMO/PPO |
$790.32
|
| Rate for Payer: Priority Health Medicare |
$229.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$608.63
|
| Rate for Payer: Railroad Medicare Medicare |
$227.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$799.40
|
| Rate for Payer: UHC Core |
$758.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.10
|
| Rate for Payer: UHC Exchange |
$227.10
|
| Rate for Payer: UHC Medicare Advantage |
$227.10
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$227.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$681.31
|
|
|
HC MR BREAST UNI SCREEN WO W CON
|
Facility
|
IP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.44 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.75
|
| Rate for Payer: BCN Commercial |
$954.04
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$925.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.35
|
| Rate for Payer: Nomi Health Commercial |
$1,012.31
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1,074.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$827.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.39
|
| Rate for Payer: UHC Core |
$1,030.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$925.90
|
|
|
HC MR BREAST UNI SCREEN WO W CON
|
Facility
|
OP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$258.20 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: Aetna Medicare |
$320.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$385.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$385.79
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$308.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.91
|
| Rate for Payer: BCN Commercial |
$959.85
|
| Rate for Payer: BCN Medicare Advantage |
$308.63
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.63
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$925.90
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.06
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$354.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.35
|
| Rate for Payer: Nomi Health Commercial |
$1,012.31
|
| Rate for Payer: PACE Senior Care Partners |
$293.20
|
| Rate for Payer: PACE SWMI |
$308.63
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: PHP Medicare Advantage |
$308.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1,074.04
|
| Rate for Payer: Priority Health Medicare |
$311.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$827.14
|
| Rate for Payer: Railroad Medicare Medicare |
$308.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.39
|
| Rate for Payer: UHC Core |
$1,030.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.63
|
| Rate for Payer: UHC Exchange |
$308.63
|
| Rate for Payer: UHC Medicare Advantage |
$308.63
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$308.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$925.90
|
|
|
HC MR BREAST UNI WO W CON
|
Facility
|
OP
|
$1,569.37
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$258.20 |
| Max. Negotiated Rate |
$1,412.43 |
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: Aetna Medicare |
$408.04
|
| Rate for Payer: Aetna Medicare |
$612.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$490.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$735.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$490.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$735.64
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$588.51
|
| Rate for Payer: BCBS MAPPO |
$392.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.26
|
| Rate for Payer: BCN Commercial |
$1,220.19
|
| Rate for Payer: BCN Commercial |
$1,830.27
|
| Rate for Payer: BCN Medicare Advantage |
$392.34
|
| Rate for Payer: BCN Medicare Advantage |
$588.51
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.51
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,177.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,765.54
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$617.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.96
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$676.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: Nomi Health Commercial |
$1,286.88
|
| Rate for Payer: Nomi Health Commercial |
$1,930.32
|
| Rate for Payer: PACE Senior Care Partners |
$372.73
|
| Rate for Payer: PACE Senior Care Partners |
$559.09
|
| Rate for Payer: PACE SWMI |
$392.34
|
| Rate for Payer: PACE SWMI |
$588.51
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: PHP Medicare Advantage |
$392.34
|
| Rate for Payer: PHP Medicare Advantage |
$588.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: Priority Health HMO/PPO |
$2,048.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,365.35
|
| Rate for Payer: Priority Health Medicare |
$396.27
|
| Rate for Payer: Priority Health Medicare |
$594.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,051.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,577.21
|
| Rate for Payer: Railroad Medicare Medicare |
$588.51
|
| Rate for Payer: Railroad Medicare Medicare |
$392.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,071.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,381.05
|
| Rate for Payer: UHC Core |
$1,965.63
|
| Rate for Payer: UHC Core |
$1,310.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.51
|
| Rate for Payer: UHC Exchange |
$588.51
|
| Rate for Payer: UHC Exchange |
$392.34
|
| Rate for Payer: UHC Medicare Advantage |
$588.51
|
| Rate for Payer: UHC Medicare Advantage |
$392.34
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$392.34
|
| Rate for Payer: VA VA |
$588.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,177.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,765.54
|
|
|
HC MR BREAST UNI WO W CON
|
Facility
|
IP
|
$1,569.37
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,020.09 |
| Max. Negotiated Rate |
$1,412.43 |
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,281.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,921.61
|
| Rate for Payer: BCN Commercial |
$1,212.81
|
| Rate for Payer: BCN Commercial |
$1,819.21
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,177.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,765.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: Nomi Health Commercial |
$1,286.88
|
| Rate for Payer: Nomi Health Commercial |
$1,930.32
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: Priority Health HMO/PPO |
$2,048.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,365.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,051.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,577.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,381.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,071.56
|
| Rate for Payer: UHC Core |
$1,310.42
|
| Rate for Payer: UHC Core |
$1,965.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,177.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,765.54
|
|
|
HC MR BREAST W CON
|
Facility
|
IP
|
$1,569.37
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,020.09 |
| Max. Negotiated Rate |
$1,412.43 |
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,281.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,921.61
|
| Rate for Payer: BCN Commercial |
$1,212.81
|
| Rate for Payer: BCN Commercial |
$1,819.21
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,177.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,765.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: Nomi Health Commercial |
$1,286.88
|
| Rate for Payer: Nomi Health Commercial |
$1,930.32
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: Priority Health HMO/PPO |
$2,048.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,365.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,051.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,577.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,381.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,071.56
|
| Rate for Payer: UHC Core |
$1,310.42
|
| Rate for Payer: UHC Core |
$1,965.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,177.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,765.54
|
|
|
HC MR BREAST W CON
|
Facility
|
OP
|
$2,354.05
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$559.09 |
| Max. Negotiated Rate |
$2,118.64 |
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna Medicare |
$612.05
|
| Rate for Payer: Aetna Medicare |
$408.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$490.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$735.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$735.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$490.43
|
| Rate for Payer: BCBS Complete |
$627.75
|
| Rate for Payer: BCBS Complete |
$941.62
|
| Rate for Payer: BCBS MAPPO |
$392.34
|
| Rate for Payer: BCBS MAPPO |
$588.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.18
|
| Rate for Payer: BCN Commercial |
$1,830.27
|
| Rate for Payer: BCN Commercial |
$1,220.19
|
| Rate for Payer: BCN Medicare Advantage |
$588.51
|
| Rate for Payer: BCN Medicare Advantage |
$392.34
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.51
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,765.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,177.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$617.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$676.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Nomi Health Commercial |
$1,930.32
|
| Rate for Payer: Nomi Health Commercial |
$1,286.88
|
| Rate for Payer: PACE Senior Care Partners |
$559.09
|
| Rate for Payer: PACE Senior Care Partners |
$372.73
|
| Rate for Payer: PACE SWMI |
$588.51
|
| Rate for Payer: PACE SWMI |
$392.34
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: PHP Medicare Advantage |
$392.34
|
| Rate for Payer: PHP Medicare Advantage |
$588.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: Priority Health HMO/PPO |
$1,365.35
|
| Rate for Payer: Priority Health HMO/PPO |
$2,048.02
|
| Rate for Payer: Priority Health Medicare |
$594.40
|
| Rate for Payer: Priority Health Medicare |
$396.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,577.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,051.48
|
| Rate for Payer: Railroad Medicare Medicare |
$392.34
|
| Rate for Payer: Railroad Medicare Medicare |
$588.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,381.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,071.56
|
| Rate for Payer: UHC Core |
$1,965.63
|
| Rate for Payer: UHC Core |
$1,310.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.34
|
| Rate for Payer: UHC Exchange |
$392.34
|
| Rate for Payer: UHC Exchange |
$588.51
|
| Rate for Payer: UHC Medicare Advantage |
$392.34
|
| Rate for Payer: UHC Medicare Advantage |
$588.51
|
| Rate for Payer: VA VA |
$392.34
|
| Rate for Payer: VA VA |
$588.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,765.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,177.03
|
|
|
HC MR BREAST WO CON BIL
|
Facility
|
OP
|
$2,132.92
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$1,919.63 |
| Rate for Payer: Aetna Commercial |
$1,812.98
|
| Rate for Payer: Aetna Medicare |
$554.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$666.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$666.54
|
| Rate for Payer: BCBS Complete |
$183.51
|
| Rate for Payer: BCBS MAPPO |
$533.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.47
|
| Rate for Payer: BCN Commercial |
$1,658.35
|
| Rate for Payer: BCN Medicare Advantage |
$533.23
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$1,834.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$533.23
|
| Rate for Payer: Healthscope Commercial |
$1,919.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,599.69
|
| Rate for Payer: Mclaren Medicaid |
$174.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$559.89
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$613.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,812.98
|
| Rate for Payer: Nomi Health Commercial |
$1,748.99
|
| Rate for Payer: PACE Senior Care Partners |
$506.57
|
| Rate for Payer: PACE SWMI |
$533.23
|
| Rate for Payer: PHP Commercial |
$1,812.98
|
| Rate for Payer: PHP Medicare Advantage |
$533.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,855.64
|
| Rate for Payer: Priority Health Medicare |
$538.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,429.06
|
| Rate for Payer: Railroad Medicare Medicare |
$533.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,876.97
|
| Rate for Payer: UHC Core |
$1,780.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$533.23
|
| Rate for Payer: UHC Exchange |
$533.23
|
| Rate for Payer: UHC Medicare Advantage |
$533.23
|
| Rate for Payer: UHCCP Medicaid |
$174.76
|
| Rate for Payer: VA VA |
$533.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,599.69
|
|
|
HC MR BREAST WO CON BIL
|
Facility
|
IP
|
$2,132.92
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,386.40 |
| Max. Negotiated Rate |
$1,919.63 |
| Rate for Payer: Aetna Commercial |
$1,812.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,741.10
|
| Rate for Payer: BCN Commercial |
$1,648.32
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$1,834.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.34
|
| Rate for Payer: Healthscope Commercial |
$1,919.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,599.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,812.98
|
| Rate for Payer: Nomi Health Commercial |
$1,748.99
|
| Rate for Payer: PHP Commercial |
$1,812.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,855.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,429.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,876.97
|
| Rate for Payer: UHC Core |
$1,780.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,599.69
|
|
