|
HC MR MRA UPPER EXTREMITY WO C
|
Facility
|
OP
|
$1,756.74
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
61000078
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$171.23 |
| Max. Negotiated Rate |
$1,581.07 |
| Rate for Payer: Aetna Commercial |
$1,493.23
|
| Rate for Payer: Aetna Commercial |
$2,239.84
|
| Rate for Payer: Aetna Medicare |
$456.75
|
| Rate for Payer: Aetna Medicare |
$685.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$548.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$548.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.47
|
| Rate for Payer: BCBS Complete |
$179.80
|
| Rate for Payer: BCBS Complete |
$179.80
|
| Rate for Payer: BCBS MAPPO |
$658.78
|
| Rate for Payer: BCBS MAPPO |
$439.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,166.32
|
| Rate for Payer: BCN Commercial |
$1,365.87
|
| Rate for Payer: BCN Commercial |
$2,048.80
|
| Rate for Payer: BCN Medicare Advantage |
$439.18
|
| Rate for Payer: BCN Medicare Advantage |
$658.78
|
| Rate for Payer: Cash Price |
$2,108.09
|
| Rate for Payer: Cash Price |
$1,405.39
|
| Rate for Payer: Cash Price |
$1,405.39
|
| Rate for Payer: Cash Price |
$2,108.09
|
| Rate for Payer: Cofinity Commercial |
$1,510.80
|
| Rate for Payer: Cofinity Commercial |
$2,266.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.78
|
| Rate for Payer: Healthscope Commercial |
$2,371.60
|
| Rate for Payer: Healthscope Commercial |
$1,581.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,976.33
|
| Rate for Payer: Mclaren Medicaid |
$171.23
|
| Rate for Payer: Mclaren Medicaid |
$171.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.14
|
| Rate for Payer: Meridian Medicaid |
$179.80
|
| Rate for Payer: Meridian Medicaid |
$179.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,239.84
|
| Rate for Payer: Nomi Health Commercial |
$1,440.53
|
| Rate for Payer: Nomi Health Commercial |
$2,160.79
|
| Rate for Payer: PACE Senior Care Partners |
$417.23
|
| Rate for Payer: PACE Senior Care Partners |
$625.84
|
| Rate for Payer: PACE SWMI |
$439.18
|
| Rate for Payer: PACE SWMI |
$658.78
|
| Rate for Payer: PHP Commercial |
$2,239.84
|
| Rate for Payer: PHP Commercial |
$1,493.23
|
| Rate for Payer: PHP Medicare Advantage |
$439.18
|
| Rate for Payer: PHP Medicare Advantage |
$658.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,712.82
|
| Rate for Payer: Priority Health HMO/PPO |
$2,292.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,528.36
|
| Rate for Payer: Priority Health Medicare |
$443.58
|
| Rate for Payer: Priority Health Medicare |
$665.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,177.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,765.52
|
| Rate for Payer: Railroad Medicare Medicare |
$658.78
|
| Rate for Payer: Railroad Medicare Medicare |
$439.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,318.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,545.93
|
| Rate for Payer: UHC Core |
$2,200.32
|
| Rate for Payer: UHC Core |
$1,466.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.78
|
| Rate for Payer: UHC Exchange |
$658.78
|
| Rate for Payer: UHC Exchange |
$439.18
|
| Rate for Payer: UHC Medicare Advantage |
$658.78
|
| Rate for Payer: UHC Medicare Advantage |
$439.18
|
| Rate for Payer: UHCCP Medicaid |
$171.23
|
| Rate for Payer: UHCCP Medicaid |
$171.23
|
| Rate for Payer: VA VA |
$439.18
|
| Rate for Payer: VA VA |
$658.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,976.33
|
|
|
HC MR MRA UPPER EXTREMITY WO W
|
Facility
|
OP
|
$2,049.38
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
61000079
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$1,844.44 |
| Rate for Payer: Aetna Commercial |
$1,741.97
|
| Rate for Payer: Aetna Commercial |
$2,612.96
|
| Rate for Payer: Aetna Medicare |
$532.84
|
| Rate for Payer: Aetna Medicare |
$799.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$640.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$960.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$640.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$960.65
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$768.52
|
| Rate for Payer: BCBS MAPPO |
$512.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,684.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,527.19
|
| Rate for Payer: BCN Commercial |
$1,593.39
|
| Rate for Payer: BCN Commercial |
$2,390.09
|
| Rate for Payer: BCN Medicare Advantage |
$512.34
|
| Rate for Payer: BCN Medicare Advantage |
$768.52
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cofinity Commercial |
$1,762.47
|
| Rate for Payer: Cofinity Commercial |
$2,643.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,459.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,639.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$768.52
|
| Rate for Payer: Healthscope Commercial |
$2,766.66
|
| Rate for Payer: Healthscope Commercial |
$1,844.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,537.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,305.55
|
| Rate for Payer: Mclaren Medicaid |
$252.98
|
| Rate for Payer: Mclaren Medicaid |
$252.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$806.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$537.96
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$589.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$883.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,612.96
|
| Rate for Payer: Nomi Health Commercial |
$1,680.49
|
| Rate for Payer: Nomi Health Commercial |
$2,520.74
|
| Rate for Payer: PACE Senior Care Partners |
$486.73
|
| Rate for Payer: PACE Senior Care Partners |
$730.09
|
| Rate for Payer: PACE SWMI |
$512.34
|
| Rate for Payer: PACE SWMI |
$768.52
|
| Rate for Payer: PHP Commercial |
$2,612.96
|
| Rate for Payer: PHP Commercial |
$1,741.97
|
| Rate for Payer: PHP Medicare Advantage |
$512.34
|
| Rate for Payer: PHP Medicare Advantage |
$768.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,998.15
|
| Rate for Payer: Priority Health HMO/PPO |
$2,674.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1,782.96
|
| Rate for Payer: Priority Health Medicare |
$517.47
|
| Rate for Payer: Priority Health Medicare |
$776.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,373.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,059.63
|
| Rate for Payer: Railroad Medicare Medicare |
$768.52
|
| Rate for Payer: Railroad Medicare Medicare |
$512.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,705.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,803.45
|
| Rate for Payer: UHC Core |
$2,566.85
|
| Rate for Payer: UHC Core |
$1,711.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$512.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$768.52
|
| Rate for Payer: UHC Exchange |
$768.52
|
| Rate for Payer: UHC Exchange |
$512.34
|
| Rate for Payer: UHC Medicare Advantage |
$768.52
|
| Rate for Payer: UHC Medicare Advantage |
$512.34
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: VA VA |
$512.34
|
| Rate for Payer: VA VA |
$768.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,537.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,305.55
|
|
|
HC MR MRA UPPER EXTREMITY WO W
|
Facility
|
IP
|
$2,049.38
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
61000079
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,332.10 |
| Max. Negotiated Rate |
$1,844.44 |
| Rate for Payer: Aetna Commercial |
$1,741.97
|
| Rate for Payer: Aetna Commercial |
$2,612.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,672.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,509.36
|
| Rate for Payer: BCN Commercial |
$1,583.76
|
| Rate for Payer: BCN Commercial |
$2,375.64
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cofinity Commercial |
$2,643.70
|
| Rate for Payer: Cofinity Commercial |
$1,762.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,459.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,639.50
|
| Rate for Payer: Healthscope Commercial |
$1,844.44
|
| Rate for Payer: Healthscope Commercial |
$2,766.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,537.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,305.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,612.96
|
| Rate for Payer: Nomi Health Commercial |
$1,680.49
|
| Rate for Payer: Nomi Health Commercial |
$2,520.74
|
| Rate for Payer: PHP Commercial |
$1,741.97
|
| Rate for Payer: PHP Commercial |
$2,612.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,998.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.10
|
| Rate for Payer: Priority Health HMO/PPO |
$2,674.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1,782.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,373.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,059.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,803.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,705.18
|
| Rate for Payer: UHC Core |
$1,711.23
|
| Rate for Payer: UHC Core |
$2,566.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,537.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,305.55
|
|
|
HC MR MRCP
|
Facility
|
OP
|
$2,110.45
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$171.23 |
| Max. Negotiated Rate |
$1,899.40 |
| Rate for Payer: Aetna Commercial |
$1,793.88
|
| Rate for Payer: Aetna Medicare |
$548.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.52
|
| Rate for Payer: BCBS Complete |
$179.80
|
| Rate for Payer: BCBS MAPPO |
$527.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,735.00
|
| Rate for Payer: BCN Commercial |
$1,640.87
|
| Rate for Payer: BCN Medicare Advantage |
$527.61
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cofinity Commercial |
$1,814.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.61
|
| Rate for Payer: Healthscope Commercial |
$1,899.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,582.84
|
| Rate for Payer: Mclaren Medicaid |
$171.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.99
|
| Rate for Payer: Meridian Medicaid |
$179.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,793.88
|
| Rate for Payer: Nomi Health Commercial |
$1,730.57
|
| Rate for Payer: PACE Senior Care Partners |
$501.23
|
| Rate for Payer: PACE SWMI |
$527.61
|
| Rate for Payer: PHP Commercial |
$1,793.88
|
| Rate for Payer: PHP Medicare Advantage |
$527.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,836.09
|
| Rate for Payer: Priority Health Medicare |
$532.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,414.00
|
| Rate for Payer: Railroad Medicare Medicare |
$527.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,857.20
|
| Rate for Payer: UHC Core |
$1,762.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.61
|
| Rate for Payer: UHC Exchange |
$527.61
|
| Rate for Payer: UHC Medicare Advantage |
$527.61
|
| Rate for Payer: UHCCP Medicaid |
$171.23
|
| Rate for Payer: VA VA |
$527.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,582.84
|
|
|
HC MR MRCP
|
Facility
|
IP
|
$2,110.45
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,371.79 |
| Max. Negotiated Rate |
$1,899.40 |
| Rate for Payer: Aetna Commercial |
$1,793.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,722.76
|
| Rate for Payer: BCN Commercial |
$1,630.96
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cofinity Commercial |
$1,814.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.36
|
| Rate for Payer: Healthscope Commercial |
$1,899.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,582.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,793.88
|
| Rate for Payer: Nomi Health Commercial |
$1,730.57
|
| Rate for Payer: PHP Commercial |
$1,793.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,836.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,414.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,857.20
|
| Rate for Payer: UHC Core |
$1,762.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,582.84
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,005.41
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$238.78 |
| Max. Negotiated Rate |
$904.87 |
| Rate for Payer: Aetna Commercial |
$854.60
|
| Rate for Payer: Aetna Medicare |
$261.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$314.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$314.19
|
| Rate for Payer: BCBS Complete |
$402.16
|
| Rate for Payer: BCBS MAPPO |
$251.35
|
| Rate for Payer: BCBS Trust/PPO |
$826.55
|
| Rate for Payer: BCN Commercial |
$781.71
|
| Rate for Payer: BCN Medicare Advantage |
$251.35
|
| Rate for Payer: Cash Price |
$804.33
|
| Rate for Payer: Cofinity Commercial |
$864.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.35
|
| Rate for Payer: Healthscope Commercial |
$904.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$754.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.60
|
| Rate for Payer: Nomi Health Commercial |
$824.44
|
| Rate for Payer: PACE Senior Care Partners |
$238.78
|
| Rate for Payer: PACE SWMI |
$251.35
|
| Rate for Payer: PHP Commercial |
$854.60
|
| Rate for Payer: PHP Medicare Advantage |
$251.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.52
|
| Rate for Payer: Priority Health HMO/PPO |
$874.71
|
| Rate for Payer: Priority Health Medicare |
$253.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$673.62
|
| Rate for Payer: Railroad Medicare Medicare |
$251.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$884.76
|
| Rate for Payer: UHC Core |
$839.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.35
|
| Rate for Payer: UHC Exchange |
$251.35
|
| Rate for Payer: UHC Medicare Advantage |
$251.35
|
| Rate for Payer: VA VA |
$251.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$754.06
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,005.41
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$653.52 |
| Max. Negotiated Rate |
$904.87 |
| Rate for Payer: Aetna Commercial |
$854.60
|
| Rate for Payer: BCBS Trust/PPO |
$820.72
|
| Rate for Payer: BCN Commercial |
$776.98
|
| Rate for Payer: Cash Price |
$804.33
|
| Rate for Payer: Cofinity Commercial |
$864.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.33
|
| Rate for Payer: Healthscope Commercial |
$904.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$754.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.60
|
| Rate for Payer: Nomi Health Commercial |
$824.44
|
| Rate for Payer: PHP Commercial |
$854.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.52
|
| Rate for Payer: Priority Health HMO/PPO |
$874.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$673.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$884.76
|
| Rate for Payer: UHC Core |
$839.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$754.06
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
IP
|
$2,216.97
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,441.03 |
| Max. Negotiated Rate |
$1,995.27 |
| Rate for Payer: Aetna Commercial |
$1,884.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,809.71
|
| Rate for Payer: BCN Commercial |
$1,713.27
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cofinity Commercial |
$1,906.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.58
|
| Rate for Payer: Healthscope Commercial |
$1,995.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,662.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.42
|
| Rate for Payer: Nomi Health Commercial |
$1,817.92
|
| Rate for Payer: PHP Commercial |
$1,884.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,441.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1,928.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,485.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,950.93
|
| Rate for Payer: UHC Core |
$1,851.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,662.73
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
OP
|
$2,216.97
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$1,995.27 |
| Rate for Payer: Aetna Commercial |
$1,884.42
|
| Rate for Payer: Aetna Medicare |
$576.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$692.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$692.80
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$554.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,822.57
|
| Rate for Payer: BCN Commercial |
$1,723.69
|
| Rate for Payer: BCN Medicare Advantage |
$554.24
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cofinity Commercial |
$1,906.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$554.24
|
| Rate for Payer: Healthscope Commercial |
$1,995.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,662.73
|
| Rate for Payer: Mclaren Medicaid |
$252.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$581.95
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$637.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.42
|
| Rate for Payer: Nomi Health Commercial |
$1,817.92
|
| Rate for Payer: PACE Senior Care Partners |
$526.53
|
| Rate for Payer: PACE SWMI |
$554.24
|
| Rate for Payer: PHP Commercial |
$1,884.42
|
| Rate for Payer: PHP Medicare Advantage |
$554.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,441.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1,928.76
|
| Rate for Payer: Priority Health Medicare |
$559.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,485.37
|
| Rate for Payer: Railroad Medicare Medicare |
$554.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,950.93
|
| Rate for Payer: UHC Core |
$1,851.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$554.24
|
| Rate for Payer: UHC Exchange |
$554.24
|
| Rate for Payer: UHC Medicare Advantage |
$554.24
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: VA VA |
$554.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,662.73
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
IP
|
$2,146.49
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,395.22 |
| Max. Negotiated Rate |
$1,931.84 |
| Rate for Payer: Aetna Commercial |
$1,824.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,752.18
|
| Rate for Payer: BCN Commercial |
$1,658.81
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cofinity Commercial |
$1,845.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.19
|
| Rate for Payer: Healthscope Commercial |
$1,931.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,609.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.52
|
| Rate for Payer: Nomi Health Commercial |
$1,760.12
|
| Rate for Payer: PHP Commercial |
$1,824.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.22
|
| Rate for Payer: Priority Health HMO/PPO |
$1,867.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,438.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,888.91
|
| Rate for Payer: UHC Core |
$1,792.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,609.87
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
OP
|
$2,146.49
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$1,931.84 |
| Rate for Payer: Aetna Commercial |
$1,824.52
|
| Rate for Payer: Aetna Medicare |
$558.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$670.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$670.78
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$536.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,764.63
|
| Rate for Payer: BCN Commercial |
$1,668.90
|
| Rate for Payer: BCN Medicare Advantage |
$536.62
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cofinity Commercial |
$1,845.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$536.62
|
| Rate for Payer: Healthscope Commercial |
$1,931.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,609.87
|
| Rate for Payer: Mclaren Medicaid |
$252.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$563.45
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.52
|
| Rate for Payer: Nomi Health Commercial |
$1,760.12
|
| Rate for Payer: PACE Senior Care Partners |
$509.79
|
| Rate for Payer: PACE SWMI |
$536.62
|
| Rate for Payer: PHP Commercial |
$1,824.52
|
| Rate for Payer: PHP Medicare Advantage |
$536.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.22
|
| Rate for Payer: Priority Health HMO/PPO |
$1,867.45
|
| Rate for Payer: Priority Health Medicare |
$541.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,438.15
|
| Rate for Payer: Railroad Medicare Medicare |
$536.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,888.91
|
| Rate for Payer: UHC Core |
$1,792.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$536.62
|
| Rate for Payer: UHC Exchange |
$536.62
|
| Rate for Payer: UHC Medicare Advantage |
$536.62
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: VA VA |
$536.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,609.87
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
OP
|
$2,035.12
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$171.23 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: Aetna Medicare |
$529.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$635.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$635.98
|
| Rate for Payer: BCBS Complete |
$179.80
|
| Rate for Payer: BCBS MAPPO |
$508.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,673.07
|
| Rate for Payer: BCN Commercial |
$1,582.31
|
| Rate for Payer: BCN Medicare Advantage |
$508.78
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Commercial |
$1,750.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.78
|
| Rate for Payer: Healthscope Commercial |
$1,831.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,526.34
|
| Rate for Payer: Mclaren Medicaid |
$171.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.22
|
| Rate for Payer: Meridian Medicaid |
$179.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$585.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Nomi Health Commercial |
$1,668.80
|
| Rate for Payer: PACE Senior Care Partners |
$483.34
|
| Rate for Payer: PACE SWMI |
$508.78
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| Rate for Payer: PHP Medicare Advantage |
$508.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.83
|
| Rate for Payer: Priority Health HMO/PPO |
$1,770.55
|
| Rate for Payer: Priority Health Medicare |
$513.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,363.53
|
| Rate for Payer: Railroad Medicare Medicare |
$508.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,790.91
|
| Rate for Payer: UHC Core |
$1,699.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.78
|
| Rate for Payer: UHC Exchange |
$508.78
|
| Rate for Payer: UHC Medicare Advantage |
$508.78
|
| Rate for Payer: UHCCP Medicaid |
$171.23
|
| Rate for Payer: VA VA |
$508.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,526.34
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
IP
|
$2,035.12
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,322.83 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.27
|
| Rate for Payer: BCN Commercial |
$1,572.74
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Commercial |
$1,750.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Healthscope Commercial |
$1,831.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,526.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Nomi Health Commercial |
$1,668.80
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.83
|
| Rate for Payer: Priority Health HMO/PPO |
$1,770.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,363.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,790.91
|
| Rate for Payer: UHC Core |
$1,699.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,526.34
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
IP
|
$2,788.74
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,812.68 |
| Max. Negotiated Rate |
$2,509.87 |
| Rate for Payer: Aetna Commercial |
$2,370.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,276.45
|
| Rate for Payer: BCN Commercial |
$2,155.14
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cofinity Commercial |
$2,398.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.99
|
| Rate for Payer: Healthscope Commercial |
$2,509.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,091.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,370.43
|
| Rate for Payer: Nomi Health Commercial |
$2,286.77
|
| Rate for Payer: PHP Commercial |
$2,370.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,812.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2,426.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,868.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,454.09
|
| Rate for Payer: UHC Core |
$2,328.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,091.56
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
OP
|
$2,788.74
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$2,509.87 |
| Rate for Payer: Aetna Commercial |
$2,370.43
|
| Rate for Payer: Aetna Medicare |
$725.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$871.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$871.48
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$697.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,292.62
|
| Rate for Payer: BCN Commercial |
$2,168.25
|
| Rate for Payer: BCN Medicare Advantage |
$697.18
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cofinity Commercial |
$2,398.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.18
|
| Rate for Payer: Healthscope Commercial |
$2,509.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,091.56
|
| Rate for Payer: Mclaren Medicaid |
$252.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.04
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$801.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,370.43
|
| Rate for Payer: Nomi Health Commercial |
$2,286.77
|
| Rate for Payer: PACE Senior Care Partners |
$662.33
|
| Rate for Payer: PACE SWMI |
$697.18
|
| Rate for Payer: PHP Commercial |
$2,370.43
|
| Rate for Payer: PHP Medicare Advantage |
$697.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,812.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2,426.20
|
| Rate for Payer: Priority Health Medicare |
$704.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,868.46
|
| Rate for Payer: Railroad Medicare Medicare |
$697.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,454.09
|
| Rate for Payer: UHC Core |
$2,328.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.18
|
| Rate for Payer: UHC Exchange |
$697.18
|
| Rate for Payer: UHC Medicare Advantage |
$697.18
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: VA VA |
$697.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,091.56
|
|
|
HC MR PELVIS W CON
|
Facility
|
OP
|
$2,243.18
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$2,018.86 |
| Rate for Payer: Aetna Commercial |
$1,906.70
|
| Rate for Payer: Aetna Medicare |
$583.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$700.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$700.99
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$560.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,844.12
|
| Rate for Payer: BCN Commercial |
$1,744.07
|
| Rate for Payer: BCN Medicare Advantage |
$560.80
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$1,929.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$560.80
|
| Rate for Payer: Healthscope Commercial |
$2,018.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,682.38
|
| Rate for Payer: Mclaren Medicaid |
$252.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$588.83
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$644.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: Nomi Health Commercial |
$1,839.41
|
| Rate for Payer: PACE Senior Care Partners |
$532.76
|
| Rate for Payer: PACE SWMI |
$560.80
|
| Rate for Payer: PHP Commercial |
$1,906.70
|
| Rate for Payer: PHP Medicare Advantage |
$560.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,951.57
|
| Rate for Payer: Priority Health Medicare |
$566.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,502.93
|
| Rate for Payer: Railroad Medicare Medicare |
$560.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,974.00
|
| Rate for Payer: UHC Core |
$1,873.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$560.80
|
| Rate for Payer: UHC Exchange |
$560.80
|
| Rate for Payer: UHC Medicare Advantage |
$560.80
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: VA VA |
$560.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,682.38
|
|
|
HC MR PELVIS W CON
|
Facility
|
IP
|
$2,243.18
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,458.07 |
| Max. Negotiated Rate |
$2,018.86 |
| Rate for Payer: Aetna Commercial |
$1,906.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,831.11
|
| Rate for Payer: BCN Commercial |
$1,733.53
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$1,929.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Healthscope Commercial |
$2,018.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,682.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: Nomi Health Commercial |
$1,839.41
|
| Rate for Payer: PHP Commercial |
$1,906.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,951.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,502.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,974.00
|
| Rate for Payer: UHC Core |
$1,873.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,682.38
|
|
|
HC MR PELVIS WO CON
|
Facility
|
IP
|
$2,032.74
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,321.28 |
| Max. Negotiated Rate |
$1,829.47 |
| Rate for Payer: Aetna Commercial |
$1,727.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,659.33
|
| Rate for Payer: BCN Commercial |
$1,570.90
|
| Rate for Payer: Cash Price |
$1,626.19
|
| Rate for Payer: Cofinity Commercial |
$1,748.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,626.19
|
| Rate for Payer: Healthscope Commercial |
$1,829.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,524.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.83
|
| Rate for Payer: Nomi Health Commercial |
$1,666.85
|
| Rate for Payer: PHP Commercial |
$1,727.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.28
|
| Rate for Payer: Priority Health HMO/PPO |
$1,768.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,788.81
|
| Rate for Payer: UHC Core |
$1,697.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,524.56
|
|
|
HC MR PELVIS WO CON
|
Facility
|
OP
|
$2,032.74
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$171.23 |
| Max. Negotiated Rate |
$1,829.47 |
| Rate for Payer: Aetna Commercial |
$1,727.83
|
| Rate for Payer: Aetna Medicare |
$528.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$635.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$635.23
|
| Rate for Payer: BCBS Complete |
$179.80
|
| Rate for Payer: BCBS MAPPO |
$508.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.12
|
| Rate for Payer: BCN Commercial |
$1,580.46
|
| Rate for Payer: BCN Medicare Advantage |
$508.18
|
| Rate for Payer: Cash Price |
$1,626.19
|
| Rate for Payer: Cash Price |
$1,626.19
|
| Rate for Payer: Cofinity Commercial |
$1,748.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,626.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.18
|
| Rate for Payer: Healthscope Commercial |
$1,829.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,524.56
|
| Rate for Payer: Mclaren Medicaid |
$171.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$533.59
|
| Rate for Payer: Meridian Medicaid |
$179.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$584.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.83
|
| Rate for Payer: Nomi Health Commercial |
$1,666.85
|
| Rate for Payer: PACE Senior Care Partners |
$482.78
|
| Rate for Payer: PACE SWMI |
$508.18
|
| Rate for Payer: PHP Commercial |
$1,727.83
|
| Rate for Payer: PHP Medicare Advantage |
$508.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.28
|
| Rate for Payer: Priority Health HMO/PPO |
$1,768.48
|
| Rate for Payer: Priority Health Medicare |
$513.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.94
|
| Rate for Payer: Railroad Medicare Medicare |
$508.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,788.81
|
| Rate for Payer: UHC Core |
$1,697.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.18
|
| Rate for Payer: UHC Exchange |
$508.18
|
| Rate for Payer: UHC Medicare Advantage |
$508.18
|
| Rate for Payer: UHCCP Medicaid |
$171.23
|
| Rate for Payer: VA VA |
$508.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,524.56
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
IP
|
$3,049.16
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,981.95 |
| Max. Negotiated Rate |
$2,744.24 |
| Rate for Payer: Aetna Commercial |
$2,591.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,489.03
|
| Rate for Payer: BCN Commercial |
$2,356.39
|
| Rate for Payer: Cash Price |
$2,439.33
|
| Rate for Payer: Cofinity Commercial |
$2,622.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,439.33
|
| Rate for Payer: Healthscope Commercial |
$2,744.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,286.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,591.79
|
| Rate for Payer: Nomi Health Commercial |
$2,500.31
|
| Rate for Payer: PHP Commercial |
$2,591.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.95
|
| Rate for Payer: Priority Health HMO/PPO |
$2,652.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,042.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,683.26
|
| Rate for Payer: UHC Core |
$2,546.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,286.87
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
OP
|
$3,049.16
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$2,744.24 |
| Rate for Payer: Aetna Commercial |
$2,591.79
|
| Rate for Payer: Aetna Medicare |
$792.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$952.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$952.86
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$762.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,506.71
|
| Rate for Payer: BCN Commercial |
$2,370.72
|
| Rate for Payer: BCN Medicare Advantage |
$762.29
|
| Rate for Payer: Cash Price |
$2,439.33
|
| Rate for Payer: Cash Price |
$2,439.33
|
| Rate for Payer: Cofinity Commercial |
$2,622.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,439.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.29
|
| Rate for Payer: Healthscope Commercial |
$2,744.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,286.87
|
| Rate for Payer: Mclaren Medicaid |
$252.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$800.40
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$876.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,591.79
|
| Rate for Payer: Nomi Health Commercial |
$2,500.31
|
| Rate for Payer: PACE Senior Care Partners |
$724.18
|
| Rate for Payer: PACE SWMI |
$762.29
|
| Rate for Payer: PHP Commercial |
$2,591.79
|
| Rate for Payer: PHP Medicare Advantage |
$762.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.95
|
| Rate for Payer: Priority Health HMO/PPO |
$2,652.77
|
| Rate for Payer: Priority Health Medicare |
$769.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,042.94
|
| Rate for Payer: Railroad Medicare Medicare |
$762.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,683.26
|
| Rate for Payer: UHC Core |
$2,546.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$762.29
|
| Rate for Payer: UHC Exchange |
$762.29
|
| Rate for Payer: UHC Medicare Advantage |
$762.29
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: VA VA |
$762.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,286.87
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
IP
|
$1,900.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,235.10 |
| Max. Negotiated Rate |
$1,710.14 |
| Rate for Payer: Aetna Commercial |
$1,615.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.10
|
| Rate for Payer: BCN Commercial |
$1,468.44
|
| Rate for Payer: Cash Price |
$1,520.13
|
| Rate for Payer: Cofinity Commercial |
$1,634.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,520.13
|
| Rate for Payer: Healthscope Commercial |
$1,710.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,425.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,615.14
|
| Rate for Payer: Nomi Health Commercial |
$1,558.13
|
| Rate for Payer: PHP Commercial |
$1,615.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,653.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,273.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,672.14
|
| Rate for Payer: UHC Core |
$1,586.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,425.12
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
OP
|
$1,900.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$1,710.14 |
| Rate for Payer: Aetna Commercial |
$1,615.14
|
| Rate for Payer: Aetna Medicare |
$494.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$593.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$593.80
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$475.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,562.12
|
| Rate for Payer: BCN Commercial |
$1,477.37
|
| Rate for Payer: BCN Medicare Advantage |
$475.04
|
| Rate for Payer: Cash Price |
$1,520.13
|
| Rate for Payer: Cash Price |
$1,520.13
|
| Rate for Payer: Cofinity Commercial |
$1,634.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,520.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.04
|
| Rate for Payer: Healthscope Commercial |
$1,710.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,425.12
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$498.79
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$546.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,615.14
|
| Rate for Payer: Nomi Health Commercial |
$1,558.13
|
| Rate for Payer: PACE Senior Care Partners |
$451.29
|
| Rate for Payer: PACE SWMI |
$475.04
|
| Rate for Payer: PHP Commercial |
$1,615.14
|
| Rate for Payer: PHP Medicare Advantage |
$475.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,653.14
|
| Rate for Payer: Priority Health Medicare |
$479.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,273.11
|
| Rate for Payer: Railroad Medicare Medicare |
$475.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,672.14
|
| Rate for Payer: UHC Core |
$1,586.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.04
|
| Rate for Payer: UHC Exchange |
$475.04
|
| Rate for Payer: UHC Medicare Advantage |
$475.04
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$475.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,425.12
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
IP
|
$2,322.34
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,509.52 |
| Max. Negotiated Rate |
$2,090.11 |
| Rate for Payer: Aetna Commercial |
$1,973.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,895.73
|
| Rate for Payer: BCN Commercial |
$1,794.70
|
| Rate for Payer: Cash Price |
$1,857.87
|
| Rate for Payer: Cofinity Commercial |
$1,997.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,857.87
|
| Rate for Payer: Healthscope Commercial |
$2,090.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,741.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,973.99
|
| Rate for Payer: Nomi Health Commercial |
$1,904.32
|
| Rate for Payer: PHP Commercial |
$1,973.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,020.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,555.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,043.66
|
| Rate for Payer: UHC Core |
$1,939.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,741.76
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
OP
|
$2,322.34
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$2,090.11 |
| Rate for Payer: Aetna Commercial |
$1,973.99
|
| Rate for Payer: Aetna Medicare |
$603.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$725.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$725.73
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$580.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,909.20
|
| Rate for Payer: BCN Commercial |
$1,805.62
|
| Rate for Payer: BCN Medicare Advantage |
$580.58
|
| Rate for Payer: Cash Price |
$1,857.87
|
| Rate for Payer: Cash Price |
$1,857.87
|
| Rate for Payer: Cofinity Commercial |
$1,997.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,857.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.58
|
| Rate for Payer: Healthscope Commercial |
$2,090.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,741.76
|
| Rate for Payer: Mclaren Medicaid |
$252.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$609.61
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$667.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,973.99
|
| Rate for Payer: Nomi Health Commercial |
$1,904.32
|
| Rate for Payer: PACE Senior Care Partners |
$551.56
|
| Rate for Payer: PACE SWMI |
$580.58
|
| Rate for Payer: PHP Commercial |
$1,973.99
|
| Rate for Payer: PHP Medicare Advantage |
$580.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,020.44
|
| Rate for Payer: Priority Health Medicare |
$586.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,555.97
|
| Rate for Payer: Railroad Medicare Medicare |
$580.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,043.66
|
| Rate for Payer: UHC Core |
$1,939.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$580.58
|
| Rate for Payer: UHC Exchange |
$580.58
|
| Rate for Payer: UHC Medicare Advantage |
$580.58
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: VA VA |
$580.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,741.76
|
|
